Jefferson Behavioral Health

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

119488 Issued in OR

Legal business name

JEFFERSON BEHAVIORAL HEALTH

Practice address

550 NE E St
Grants Pass, OR 97526-2326

Phone

(541) 955-9565

Fax

(541) 955-8290

NPI assigned

Jul 30, 2007

Last updated

Aug 11, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Bob Nikkel

Title

Executive Director

Phone

(541) 955-9565

Specialties & licenses 1

Addresses

Tax ID family

Jefferson Behavioral Health2 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.

• Jefferson Behavioral Health

  • Exclusive Provider Organization
  • Grants Pass, OR
  • NPI 1861575912
  NPD tax ID

Locations

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1750571345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 NE E ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262326",
            "telephone_number": "541-955-9565",
            "fax_number": "541-955-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NE E ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975262326",
            "telephone_number": "541-955-9565",
            "fax_number": "541-955-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "NIKKEL",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-955-9565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "OR",
            "license": "119488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vianney Lissett Jauregui Hernandez
• Lauren Javernick, M.D.
• Quianna Elizabeth Javernick, CCC-SLP
• Robert D Jaynes
• Christina Lynn Jeffers, LMT
• Jefferson Behavioral Health
• Peggy Sue Jenkins, EARLY CHILDHOOD CERT
• Jo M Jenner, ND
• Jordan Jennings
• Keith Andrew Jensen, CRNA

• Exclusive Provider Organization in Grants Pass, OR
• Providers in Grants Pass, OR by specialty
• Exclusive Provider Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; 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.