Provider Demographics
NPI:1366953861
Name:ORTC, LLC
Entity type:Organization
Organization Name:ORTC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-322-1794
Mailing Address - Street 1:155 NE REVERE AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4147
Mailing Address - Country:US
Mailing Address - Phone:541-617-4544
Mailing Address - Fax:541-749-2126
Practice Address - Street 1:155 NE REVERE AVE STE 150
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4147
Practice Address - Country:US
Practice Address - Phone:541-617-4544
Practice Address - Fax:541-749-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEND TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-24
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38D2134657Medicaid