NPIMap

Organization Active NPI

Royal Ave Program

  • Mental Health Counselor
  • Eugene, OR
National Provider Identifier
1184983173
Registry record updated May 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
ROYAL AVE PROGRAM
Practice address
499 W 4TH Ave
Eugene, OR 97401-2505
Phone
(541) 686-1262
Fax
(541) 686-0359
NPI assigned
May 10, 2012
Organization subpart
Yes
Parent organization
SHELTERCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erin Bonner
Title
Assistant Exective Director
Phone
(541) 686-1262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

499 W 4TH Ave
Eugene, OR 97401-2505

Mailing address

780 Highway 99 N
Eugene, OR 97402-2301
Phone (541) 686-1262

Other identifiers 1

IdentifierTypeStateIssuer
233701MedicaidOR

Other names 1

  • Sheltercare Other name

National Provider Directory

National Provider Directory
Tax ID family
Heeran Center3 organizations share this tax ID, including this one
Part of
Heeran Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

499 W 4th Ave
Eugene, OR 97401
Phone (541) 505-5188

780 Highway 99 N
Eugene, OR 97402
Phone (541) 461-2845

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/sheltercare/r4/

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1184983173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 HIGHWAY 99 N",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974022301",
            "telephone_number": "541-686-1262",
            "fax_number": "541-686-1262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "499 W 4TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974012505",
            "telephone_number": "541-686-1262",
            "fax_number": "541-686-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROYAL AVE PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHELTERCARE",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "ASSISTANT EXECTIVE  DIRECTOR",
        "authorized_official_telephone_number": "541-686-1262"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "233701",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sheltercare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.