COW CREEK HEALTH & WELLNESS CTR (NPI# 1205104718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205104718 |
| Entity Type | Organization |
| Organization Name | COW CREEK HEALTH & WELLNESS CTR |
| Other Organization Name | COW CREEK BAND OF UMPQUA TRIBE OF INDIANS |
| Practice Address |
2371 Ne Stephens St Ste 200 Roseburg OR 97470-1399 |
| Practice Telephone | 5416728533 |
| Practice Fax Number | 5416724993 |
| Mailing Telephone | 5416728533 |
| Mailing Fax Number | 5416724993 |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |
| Authorized Official Name | MICHAEL J RONDEAU (CEO) |
| Authorized Official Telephone | 5416729405 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
10-09-68U | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 165772 | 05 |
| Other Name | Type Code |
|---|---|
| Cow Creek Band of Umpqua Tribe of Indians | Former Legal Business Name - Organization |
| Street Address |
2371 NE STEPHENS ST STE 200 |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97470-1399 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063502714 | Cow Creek Band of Umpqua Tribe of Indians | Clinic/Center | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2006-10-13 |
| 1912565649 | Darlene Chapman | Assistant Behavior Analyst | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2019-05-29 |
| 1386127298 | Lauren Michelle Haddock | Dietitian, Registered | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2018-09-07 |
| 1598923252 | Donald Dale Gilbert | Counselor | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2008-05-29 |
| 1942481650 | Mary L Hagood | Family Medicine | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2007-11-21 |
| 1285795583 | Mark William Macdonald | Family Medicine | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2006-12-12 |
| 1063570463 | Patricia A Hedges | Family Medicine | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2006-12-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326547134 | Thoughtwork, LLC | Social Worker | 178 Nw Garden Valley Blvd, Roseburg, OR 97470 | 2018-02-07 |
| 1063932960 | Go Mo, LLC | Durable Medical Equipment & Medical Supplies | 627 Se Jackson St, Roseburg, OR 97470 | 2017-06-21 |
| 1497123335 | Brandi N Hamilton | Counselor | 215 S.e. Jackson, Roseburg, OR 97470 | 2015-09-09 |
| 1285031203 | Aric Fromdahl | Counselor | 215 Se Jackson, Roseburg, OR 97470 | 2014-11-20 |
| 1801292438 | Robin Knebel | Counselor | 215 Se Jackson St., Roseburg, OR 97470 | 2014-11-10 |
| 1700282415 | Samantha Marie Shelley | Counselor | 215 Se Jackson Street, Roseburg, OR 97470 | 2014-11-06 |
| 1043610660 | Cynthia Simmons | Counselor | 150 Ne Kenneth Ford Drive, Roseburg, OR 97470 | 2014-09-02 |
| 1083025431 | Toni Damewood Msn Pmhnp-bc | Nurse Practitioner | 770 Se Kane Street, Roseburg, OR 97470 | 2014-05-19 |
| 1801226196 | Denise Ingeman | Registered Nurse | 1548 South East Pine Street, Roseburg, OR 97470 | 2013-11-22 |
| 1356606909 | Carla Junette Rambel | Massage Therapist | 566 S.e. Jackson, Roseburg, OR 97470 | 2012-07-10 |
| Find all providers in zip 97470 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710330386 | Serenity Lane | Counselor | 2575 Nw Kline St, Roseburg, OR 97471-8827 | 2016-07-19 |
| 1306205984 | Susan Anne Dowell | Counselor | 548 Se Jackson Street, Roseburg, OR 97470-0254 | 2016-02-11 |
| 1528426517 | William C. Poulter | Counselor | 548 Sw Jackson St, Roseburg, OR 97470-2709 | 2016-02-04 |
| 1508295668 | Adapt | Counselor | 1215 Se Court Ave, Roseburg, OR 97470-4329 | 2013-11-08 |
| 1174952238 | Adapt | Counselor | 550 Se Jackson St, Roseburg, OR 97470-4923 | 2013-11-08 |
| 1639508708 | Adapt | Counselor | 1036 Se Douglas Ave, Roseburg, OR 97470-3301 | 2013-11-08 |
| 1245597582 | Alison Marie Hinson | Counselor | 850 Se Rose St, Roseburg, OR 97470-3942 | 2012-04-11 |
| 1114112133 | Delila S Donaldson | Counselor | 727 Se Cass Ave Ste 223, Roseburg, OR 97470-4953 | 2007-09-12 |
| 1639256431 | Linda Witbeck | Counselor | 913 Garden Valley Blvd, Bldg 2, Ward 2, Sartp, Roseburg, OR 97470 | 2006-11-01 |
| 1750373346 | Adapt | Counselor | 548 Se Jackson St, Roseburg, OR 97470-4983 | 2005-08-18 |
| Find all providers in ROSEBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.