Childerns Farm Home
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Corvallis, OR. Organization (NPI-2).
NPI number1457561524
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1457561524
- Entity type
- Organization (NPI-2)
- Legal business name
- Childerns Farm Home
- Organization subpart
- No
- Enumeration date
- May 23, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | 320600000x | OR | Yes |
Practice location
2820 Se Glenn StCorvallis, OR 97333-2121
Phone 541-750-1121
Mailing address
2820 Se Glenn StCorvallis, OR 97333-2121
Phone 541-750-1121
Authorized official
Joshua Taylor Copeland
Lead Ttl Powers
5417501121
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