Provider Demographics
NPI:1699581918
Name:GOLDEN RULE REENTRY
Entity type:Organization
Organization Name:GOLDEN RULE REENTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHASTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSS/JITHW
Authorized Official - Phone:541-930-8932
Mailing Address - Street 1:2305 ASHLAND ST # C-350
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3777
Mailing Address - Country:US
Mailing Address - Phone:541-693-0893
Mailing Address - Fax:
Practice Address - Street 1:715 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2924
Practice Address - Country:US
Practice Address - Phone:541-930-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty