Provider Demographics
NPI:1285719195
Name:OLD MILL CENTER FOR CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:OLD MILL CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARKINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-757-8068
Mailing Address - Street 1:1650 SW 45TH PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333
Mailing Address - Country:US
Mailing Address - Phone:541-757-8068
Mailing Address - Fax:541-758-1030
Practice Address - Street 1:1650 SW 45TH PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333
Practice Address - Country:US
Practice Address - Phone:541-757-8068
Practice Address - Fax:541-758-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128715Medicaid
OR100172OtherSTATE OF OREGON