Provider Demographics
NPI:1588692040
Name:RECONNECTIONS A AND D
Entity type:Organization
Organization Name:RECONNECTIONS A AND D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LALORI
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:LAGER
Authorized Official - Suffix:
Authorized Official - Credentials:BS CADC II
Authorized Official - Phone:541-574-9570
Mailing Address - Street 1:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-574-9570
Mailing Address - Fax:541-574-8857
Practice Address - Street 1:1010 NW COAST HWY
Practice Address - Street 2:#307
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-574-9570
Practice Address - Fax:541-574-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR135900Medicaid