Doctor Name: | ELIZABETH PANUCO |
NPI Number: | 1962883793 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 7828147 |
Business Practice Address: | 121 Iowa St Klamath Falls, OR - 976011606 |
Business Phone Number: | 5418831030 |
Business Fax Number: | |
Mailing Address: | 883 Homedale Rd, KLAMATH FALLS |
State: | OR |
Postal Code: | 976033942 |
Phone Number: | 5418917150 |
Fax Number: | |
NPI Enumeration Date: | 06/17/2015 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | 7828147 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |