MR. VERNON ROSE JR. (NPI# 1356872477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356872477 |
| Entity Type | Individual |
| Full Name | MR. VERNON ROSE JR. |
| Credential | CADC II |
| Practice Address |
4211 W 11th Ave Eugene OR 97402-5435 |
| Practice Telephone | 5414851577 |
| Practice Fax Number | 5412422853 |
| Mailing Telephone | 5414851577 |
| Mailing Fax Number | 5412422853 |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2020-10-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
07-09-64 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | CERTIFIED ALCOHOL AND DRUG COUNSELOR LEVEL II | 07-09-64 | 01 |
| OR | 500730386 | 05 |
| Street Address |
4211 W 11TH AVE |
| City | EUGENE |
| State | OR |
| Zip Code | 97402-5435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497113765 | Nathan Mart | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2016-02-02 |
| 1730706417 | Alexis Von Egidy | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2020-06-29 |
| 1275188328 | Georgia Marie Bronson | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2019-08-06 |
| 1902374283 | Bryan Jesse Brown | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2018-11-05 |
| 1932617198 | Jaclyn Levy | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2018-01-22 |
| 1467999276 | Stuart Moore | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2017-01-31 |
| 1477090397 | Christopher Brandon Benz | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2017-01-30 |
| 1114385945 | Kevin Higgins | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2016-02-08 |
| 1295193027 | Maxwell Sears | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2016-02-08 |
| 1770941502 | Denise Cole | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2016-02-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538709704 | Jordan Charles Smith | Massage Therapist | 775 Menroe St., Eugene, OR 97402 | 2020-01-15 |
| 1104462134 | Cerridwen Laurel Martin | Massage Therapist | 775 Monroe St., Eugene, OR 97402 | 2019-11-25 |
| 1720556368 | Valerie Jeanne Charles | Massage Therapist | 989 Throne Dr., Eugene, OR 97402 | 2018-11-12 |
| 1407324189 | Laura Angulo | Massage Therapist | 1247 W 8th Ave Apt 10, Eugene, OR 97402 | 2018-11-11 |
| 1932687472 | Karl Alan Porter | Counselor | 1195 City View St Ste B, Eugene, OR 97402 | 2018-08-06 |
| 1992283170 | Fresenius Medical Care Dialysis Services - Oregon, LLC | Clinic/Center | 3747 W 11th Ave, Eugene, OR 97402 | 2018-07-31 |
| 1699251744 | Isabella Arlo Jane Silver | Counselor | 970 W 7th Ave., Eugene, OR 97402 | 2018-07-12 |
| 1447740527 | Shasta Tobi Cooke | Behavioral Analyst | 677 1/2 W 12th Ave, Eugene, OR 97402 | 2018-05-15 |
| 1497205306 | Jenna Bracco | Social Worker | 1274 W. 7th Avenue Suite 201, Eugene, OR 97402 | 2016-10-04 |
| 1871041392 | Jeremy Powers | Massage Therapist | 882 Van Buren St, Eugene, OR 97402 | 2016-09-13 |
| Find all providers in zip 97402 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427619659 | Erika Casey | Counselor | 1572 Mckinley Ct, Eugene, OR 97402-3440 | 2019-06-27 |
| 1346760345 | Elicea Manners | Counselor | 78a Centennial Loop, Eugene, OR 97401 | 2017-06-21 |
| 1306386438 | Shelby Afton Marie Slay | Counselor | 1246 River Rd, Eugene, OR 97404-2633 | 2017-03-08 |
| 1629515408 | Laura Willow | Counselor | 2162 Riverview St, Eugene, OR 97403-2238 | 2017-01-31 |
| 1699217471 | Leslie Ann Bletscher | Counselor | 900 River Loop 1, Eugene, OR 97404-1494 | 2016-11-10 |
| 1467904045 | Linda Vik | Counselor | 304 Dartmoor Dr, Eugene, OR 97401-5728 | 2016-10-28 |
| 1255883047 | Forrest Beesley | Counselor | 3091 Portland St, Eugene, OR 97405-3394 | 2016-10-27 |
| 1992257844 | Molly Kate Gelinas | Counselor | 77 Stults Ave, Eugene, OR 97404-3269 | 2016-10-26 |
| 1376903120 | Patricia Hummel | Counselor | 616 East 16th Avenue, Eugene, OR 97401 | 2016-03-07 |
| 1497113765 | Nathan Mart | Counselor | 4211 W 11th Ave, Eugene, OR 97402-5435 | 2016-02-02 |
| Find all providers in EUGENE | ||||
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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.