KLAMATH YOUTH DEVELOPMENT CENTER (NPI# 1396172375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396172375 |
| Entity Type | Organization |
| Organization Name | KLAMATH YOUTH DEVELOPMENT CENTER |
| Other Organization Name | KLAMATH CHILD AND FAMILY TREATMENT CENTER |
| Practice Address |
2210 N Eldorado Ave Klamath Falls OR 97601-6418 |
| Practice Telephone | 5418831030 |
| Mailing Telephone | 5418831030 |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2013-10-04 |
| Authorized Official Name | MRS. JENNY ELLEN WHEELER (TRANSITION CORDINATOR SBS) |
| Authorized Official Telephone | 5415915604 |
| Authorized Official Credential | BS, CADC I |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | OR | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 223354 | 05 |
| Other Name | Type Code |
|---|---|
| Klamath Child and Family Treatment Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578991709 | Klamath Youth Development Center | Community/Behavioral Health | 2210 N Eldorado Ave, Klamath Falls, OR 97601 | 2013-10-25 |
| 1639515018 | Klamath Youth Development Center | Community/Behavioral Health | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2013-05-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KLAMATH YOUTH DEVELOPMENT CENTER | 2210 N Eldorado, Klamath Falls, OR 97601 |
| Street Address |
2210 N ELDORADO AVE |
| City | KLAMATH FALLS |
| State | OR |
| Zip Code | 97601-6418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902830524 | Klamath Child and Family Treatment Center | Voluntary or Charitable | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2006-07-10 |
| 1467051524 | Anthony Victor Anghinetti | Case Manager/Care Coordinator | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-10-20 |
| 1013514827 | Kassie Anderson | Peer Specialist | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-10-05 |
| 1821604828 | Ryan Matthew Conrady | Peer Specialist | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-09-16 |
| 1730795733 | Joy June Hobbs | Case Manager/Care Coordinator | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-09-16 |
| 1821603762 | Alejandra Avalos Vasquez | Case Manager/Care Coordinator | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-09-08 |
| 1154935542 | Deanna Kay Garren | Case Manager/Care Coordinator | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-09-02 |
| 1619581006 | Meghan Rae Gorbett | Case Manager/Care Coordinator | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-09-02 |
| 1710595160 | Katrina V Hopf | Peer Specialist | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-07-21 |
| 1104434554 | Laurie Rae Cooper | Counselor | 2210 N Eldorado Ave, Klamath Falls, OR 97601-6418 | 2020-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205487311 | Socorro Guadalupe Alcala- Peres | Case Manager/Care Coordinator | 2210 N El Dorado Ave, Klamath Falls, OR 97601 | 2019-09-20 |
| 1033760053 | Melissa Ann Roy | Counselor | 2210 North El Dorado, 2210 North El Dorado, Klamath Falls, OR 97601 | 2019-09-20 |
| 1134699721 | Kristin Asta Ragnarsson | Speech-Language Pathologist | Plum Ridge Care 1401 Bryant Williams, Klamath Falls, OR 97601 | 2018-11-27 |
| 1730667445 | Nancy Leota Baley | Pharmacist | Sky Lakes Outpatient Pharmacy, 2865 Daggett Street, Klamath Falls, OR 97601 | 2018-08-03 |
| 1336511260 | Patricia Blauvelt | Occupational Therapy Assistant | 1401 Bryant Williams Dr, Klamath Falls, OR 97601 | 2015-10-30 |
| 1598160814 | Christopher S. Turner | Counselor | 635 Main St., Klamath Falls, OR 97601 | 2014-10-29 |
| 1134472582 | Whole Person Care Family Practice | Family Medicine | 2301 Mountainview Blvd. Ste B, Klamath Falls, OR 97601 | 2012-10-23 |
| 1255692687 | Billy Dean Vermaas | Physical Medicine & Rehabilitation | 204 N. 10th Street, Klamath Falls, OR 97601 | 2012-06-01 |
| 1407140700 | Wendell C Heidinger Md | Family Medicine | 2301 Clairmont Drive, Klamath Falls, OR 97601 | 2011-06-03 |
| 1740573146 | Klamath Youh Department Center | Community/Behavioral Health | 2210 Eldordo Ave, Klamath Falls, OR 97601 | 2011-05-18 |
| Find all providers in zip 97601 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356858369 | Scott Richardson | Community Based Residential Treatment Facility, Mental Illness | 3934 Rio Vista Way, Klamath Falls, OR 97603 | 2017-12-29 |
| 1053563403 | Dragonfly Adventures, Inc | Community Based Residential Treatment Facility, Mental Illness | 919 High St, Klamath Falls, OR 97601-2830 | 2008-10-16 |
| 1962883793 | Elizabeth Panuco | Community Based Residential Treatment Facility, Mental Illness | 121 Iowa St, Klamath Falls, OR 97601-1606 | 2015-06-17 |
| 1992949796 | Klamath Child and Family Treatment Center | Community Based Residential Treatment Facility, Mental Illness | 725 Washburn Way, Klamath Falls, OR 97603-3648 | 2009-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255932059 | Rainrock Treatment Center, LLC | Community Based Residential Treatment Facility, Mental Illness | 2990 Brandywine Dr, West Linn, OR 97068-8313 | 2020-11-06 |
| 1770101545 | Northwest Premier LLC | Community Based Residential Treatment Facility, Mental Illness | 560 W Rose St, Lebanon, OR 97355-2624 | 2020-07-08 |
| 1538793856 | Tamekio Russell | Community Based Residential Treatment Facility, Mental Illness | 2072 Sw Sandlewood Pl, Gresham, OR 97080-9752 | 2020-02-25 |
| 1487290342 | Andrew J Thomas | Community Based Residential Treatment Facility, Mental Illness | 2568 Sw 1st Ave, Ontario, OR 97914-1877 | 2019-11-25 |
| 1760046528 | The Sachiko Group, Inc | Community Based Residential Treatment Facility, Mental Illness | 3517 Sw Wonderview Ave, Gresham, OR 97080-8574 | 2019-04-26 |
| 1831660984 | Olthyme LLC | Community Based Residential Treatment Facility, Mental Illness | 30803 Jeppeson Ln, Hermiston, OR 97838-6222 | 2018-12-16 |
| 1679073712 | Columbacare Services | Community Based Residential Treatment Facility, Mental Illness | 622 57th St, Springfield, OR 97478-6821 | 2018-02-15 |
| 1558877407 | Best Care Treatment Services | Community Based Residential Treatment Facility, Mental Illness | 1470 Nw 4th St, Redmond, OR 97756-1366 | 2017-12-14 |
| 1831640192 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 8336 Highway 62, White City, OR 97530 | 2016-10-20 |
| 1740733906 | Trillium Family Services | Community Based Residential Treatment Facility, Mental Illness | 4545 Ne Highway 20, Corvallis, OR 97330-9655 | 2016-07-25 |
| Find all providers with the same taxonomy | ||||
| City | KLAMATH FALLS |
| Zip Code | 97601 |
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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.