| Organization Name: | VA SOUTHERN OREGON |
| NPI Number: | 1124198999 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WOLFGANG LAURENCE AGOTTA (DUAL-DIAGNOSIS THERAPIST) |
| Mailing Address: | 8495 Crater Lake Hwy White City |
| State: | OR US |
| Postal Code: | 975033011 |
| Phone Number: | 5418262111 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |