Provider Demographics
NPI:1144345570
Name:CATHOLIC COMMUNITY SERVICES OF THE MID-WILLAMETTE VALLEY AND CENTRAL
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF THE MID-WILLAMETTE VALLEY AND CENTRAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANFROI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-856-7006
Mailing Address - Street 1:3737 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-390-2600
Mailing Address - Fax:503-390-8629
Practice Address - Street 1:3737 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-390-2600
Practice Address - Fax:503-390-8629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC COMMUNITY SERVICES OF THE MID-WILLAMETTE VALLEY AND CENTRAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226320OtherISN PROVIDER NUMBER
182536OtherNEW STEP
OR030585OtherCCC OMAP PROVIDER NUMBER
OR261545OtherRAINBOW PROVIDER NUMBER
OR182536OtherNS PROVIDER NUMBER
OR226320OtherCYFS PROVIDER NUMBER
OR230442OtherCCC PROVIDER NUMBER
230442OtherCOUNSEL
OR931280935OtherISN TAX ID
OR261545OtherRAINBOW PROVIDER NUMBER