Provider Demographics
NPI:1366697690
Name:COUNTY OF DOUGLAS
Entity type:Organization
Organization Name:COUNTY OF DOUGLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:JUVENILE DEPARTMENT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-440-4415
Mailing Address - Street 1:1036 SE DOUGLAS AVE
Mailing Address - Street 2:JUSTICE BUILDING, ROOM 203
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3301
Mailing Address - Country:US
Mailing Address - Phone:541-464-6404
Mailing Address - Fax:541-464-6420
Practice Address - Street 1:215 SE JACKSON ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3341
Practice Address - Country:US
Practice Address - Phone:541-464-6404
Practice Address - Fax:541-464-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health