Provider Demographics
NPI:1427423912
Name:MID LANE CARES
Entity type:Organization
Organization Name:MID LANE CARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-935-4555
Mailing Address - Street 1:25035 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-8795
Mailing Address - Country:US
Mailing Address - Phone:541-935-4555
Mailing Address - Fax:541-935-4531
Practice Address - Street 1:25035 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-8795
Practice Address - Country:US
Practice Address - Phone:541-935-4555
Practice Address - Fax:541-935-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service