Provider Demographics
NPI:1124845540
Name:YOUNG ROOTS OREGON
Entity type:Organization
Organization Name:YOUNG ROOTS OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-990-4504
Mailing Address - Street 1:PO BOX 3268
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-0710
Mailing Address - Country:US
Mailing Address - Phone:541-990-4504
Mailing Address - Fax:
Practice Address - Street 1:1620 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4871
Practice Address - Country:US
Practice Address - Phone:541-990-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management