Provider Demographics
NPI:1144677345
Name:EVOKE
Entity type:Organization
Organization Name:EVOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-382-1620
Mailing Address - Street 1:20332 EMPIRE AVE
Mailing Address - Street 2:SUITE F-7
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5712
Mailing Address - Country:US
Mailing Address - Phone:541-382-1620
Mailing Address - Fax:541-382-1817
Practice Address - Street 1:20332 EMPIRE AVE
Practice Address - Street 2:SUITE F-7
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5712
Practice Address - Country:US
Practice Address - Phone:541-382-1620
Practice Address - Fax:541-382-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4041320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness