Jasper Mountain
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Jasper, OR
NPI 1497821680 · NPPES record last updated Mar 8, 2024
Key facts
- NPI
- 1497821680
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- Legal business name
- JASPER MOUNTAIN
- Practice address
- 37875 Jasper Lowell Rd
Jasper, OR 97438-9751 - Phone
- (541) 747-1235
- Fax
- (541) 747-4722
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Carita Chantel Lively
- Title
- Compliance Specialist
- Phone
- (541) 747-1235
Practitioners 364
-
Ryan Adams, MSW
-
Scott Avila, M.D.I.V., QMHA
-
Jordan Bandaogo, B.A.; QMHA
-
Brittany Barnes, B.A.
-
Giselle Barone, MA
-
Anderson Paul Beals, B.S.
-
Anne Beam, B.S., QMHA
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | OR | Yes | |
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | OR | ||
| Psychiatric Residential Treatment Facility | 323P00000X | |||
| Child Mental Illness Respite Care | 385HR2055X | OR |
Addresses
Primary practice location
37875 Jasper Lowell Rd
Jasper, OR 97438-9751
Mailing address
37875 Jasper Lowell Rd
Jasper, OR 97438-9751
Phone (541) 747-1235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 313495 | Medicaid | OR | |
| 178087 | Medicaid | OR |
Other providers in Jasper, OR
- Parker Clifton Huff
- Sarah Huff
- Eden Huston
- Joshua Michael Hutchinson
- Hana Imai
- Jasper Mountain
- Gretchen Gay Jenness
- Gina Marie Jensen
- Anthony Jiminez
- Cameron Jones
All providers in Jasper, OR · Mental Illness Community Based Residential Treatment Facility in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.