La Pine KTC, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

LA PINE KTC, LLC

Practice address

16161 Burgess Rd
La Pine, OR 97739-9533

Phone

(509) 668-8008

Fax

(503) 432-8913

NPI assigned

Oct 23, 2015

Organization subpart

Yes

Parent organization

WHITE RABBIT PARTNERSAs reported in NPPES

Name

Milton Parham

Title

Chief Business Development Officer

Phone

(509) 668-8008

Tax ID family

Bend Iop2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Bend Iop

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bend, OR
  • NPI 1518419779
  NPD tax ID

Locations

• KLEAN La Pine Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 23, 2015.

{
    "created_epoch": "1445558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1700258258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16161 BURGESS RD",
            "city": "LA PINE",
            "state": "OR",
            "postal_code": "977399533",
            "telephone_number": "509-668-8008",
            "fax_number": "503-432-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16161 BURGESS RD",
            "city": "LA PINE",
            "state": "OR",
            "postal_code": "977399533",
            "telephone_number": "509-668-8008",
            "fax_number": "503-432-8913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PINE KTC, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE RABBIT PARTNERS",
        "enumeration_date": "2015-10-23",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "PARHAM",
        "authorized_official_first_name": "MILTON",
        "authorized_official_title_or_position": "CHIEF BUSINESS DEVELOPMENT OFFICER",
        "authorized_official_telephone_number": "509-668-8008"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KLEAN La Pine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• La Pine Community Health Center
• La Pine Community Health Center
• La Pine Community Health Center
• La Pine Community Health Center
• La Pine Community Health Center
• La Pine Rural Fire Protection District
• Tyson Lee Langeliers, PA -C, ATC, LAT
• Lapine Community Clinic, LLC
• Casey Scott Law, MD
• Rio Lion, D.O

• All providers in La Pine, OR
• Substance Abuse Rehabilitation Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.