Organization Name: | LA PINE KTC, LLC |
NPI Number: | 1700258258 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MILTON PARHAM (CHIEF BUSINESS DEVELOPMENT OFFICER) |
Mailing Address: | 16161 Burgess Rd La Pine |
State: | OR US |
Postal Code: | 977399533 |
Phone Number: | 5096688008 |
Fax Number: | 5034328913 |
NPI Enumeration Date: | 10/23/2015 |
NPI Last Update Date: | 10/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
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. |