Provider Demographics
NPI:1548461668
Name:CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL COAST
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:BS, QMHA
Authorized Official - Phone:503-856-7061
Mailing Address - Street 1:PO BOX 20400
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-0400
Mailing Address - Country:US
Mailing Address - Phone:503-856-7061
Mailing Address - Fax:503-463-6280
Practice Address - Street 1:3737 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-2511
Practice Address - Country:US
Practice Address - Phone:503-856-7061
Practice Address - Fax:503-463-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management