Provider Demographics
NPI:1063585065
Name:JACKSON CO CHILD ABUSE TASK FORCE INC
Entity type:Organization
Organization Name:JACKSON CO CHILD ABUSE TASK FORCE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-734-5437
Mailing Address - Street 1:816 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3016
Mailing Address - Country:US
Mailing Address - Phone:541-734-5437
Mailing Address - Fax:541-734-2425
Practice Address - Street 1:816 W 10TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3016
Practice Address - Country:US
Practice Address - Phone:541-734-5437
Practice Address - Fax:541-734-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
232518Medicare UPIN