CHARLES KEITH SANBORN (NPI# 1083279640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083279640 |
| Entity Type | Individual |
| Full Name | CHARLES KEITH SANBORN |
| Practice Address |
357 Ne Court St Prineville OR 97754-1936 |
| Practice Telephone | 5415047535 |
| Practice Fax Number | 5415047535 |
| Mailing Telephone | 5415047535 |
| Mailing Fax Number | 5415047535 |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
500654390 | OR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500654390 | 05 |
| Street Address |
357 NE COURT ST |
| City | PRINEVILLE |
| State | OR |
| Zip Code | 97754-1936 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265771604 | Choices Recovery Services, LLC | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2013-02-05 |
| 1508491994 | Daryl Allen Lee | Peer Specialist | 357 Ne Court St, Prineville, OR 97754-1936 | 2020-03-06 |
| 1295384170 | Kayle Ryn Shrauger | Peer Specialist | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-09-04 |
| 1518522259 | Page Pedder | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-05-08 |
| 1265097604 | Andrea Hope Olsen | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-05-01 |
| 1144784380 | Corinne Rachelle Knox | Registered Nurse | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598246290 | Phyllis Louise Young | Physical Therapy Assistant | 350 Ne Brennan Ln, Prineville, OR 97754 | 2018-08-22 |
| 1316424518 | Monte Bainbridge | Counselor | 1103 Ne Elm St Ste B, Prineville, OR 97754 | 2018-07-20 |
| 1841739760 | Gregory Wayne Sanders | Marriage & Family Therapist | 445 Nw 3rd Street, Prineville, OR 97754 | 2017-02-13 |
| 1114474962 | Amy R Duryea | Counselor | 1103 Ne Elm St., Prineville, OR 97754 | 2016-09-08 |
| 1669855052 | Rebecca L Griffith | Mechanotherapist | 298 N Holly St, Prineville, OR 97754 | 2015-07-02 |
| 1376810838 | Jessica Lynn Neely | Counselor | 1333 Nw 9th Street, Prineville, OR 97754 | 2011-11-28 |
| 1205076130 | Dean Arthur Laney | Registered Nurse | 375 Nw Beaver St., Suite 100, Prineville, OR 97754 | 2009-03-05 |
| 1699910513 | Ross E Weakley | Acupuncturist | 298 Sw Harwood, Prineville, OR 97754 | 2008-12-05 |
| 1326208752 | Laura Danielle Gratton | Family Medicine | 975 Nw Beaver Street, Prineville, OR 97754 | 2008-06-10 |
| 1811174550 | Central Oregon Eyecare, PC | Optometrist | 198 Ne Combs Flat Rd, Ste 120, Prineville, OR 97754 | 2008-01-24 |
| Find all providers in zip 97754 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245571777 | Chrystal Kay Johnson | Counselor | 190 Nw 4th St, Prineville, OR 97754-1820 | 2013-03-07 |
| 1265771604 | Choices Recovery Services, LLC | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2013-02-05 |
| 1396002440 | Silvia C Gonzalez | Counselor | 550 Nw 5th St, 360 Nw Beaver St, Prineville, OR 97754-1728 | 2012-04-13 |
| 1376810838 | Jessica Lynn Neely | Counselor | 1333 Nw 9th Street, Prineville, OR 97754 | 2011-11-28 |
| 1497073050 | Darla Kay Byus | Counselor | 709 Ne 3rd St, Prineville, OR 97754-2023 | 2010-05-06 |
| 1114118833 | Gearl C Seal | Counselor | 205 Ne 4th St, Prineville, OR 97754-1925 | 2007-08-07 |
| 1952450249 | Ogilvia Pineda | Counselor | 365 Ne Court St, Prineville, OR 97754-1936 | 2007-01-09 |
| 1104423565 | Nicole Hendrickson | Counselor | 1059 Nw Madras Hwy, Prineville, OR 97754-1416 | 2020-10-07 |
| 1518522259 | Page Pedder | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-05-08 |
| 1265097604 | Andrea Hope Olsen | Counselor | 357 Ne Court St, Prineville, OR 97754-1936 | 2019-05-01 |
| Find all providers in PRINEVILLE | ||||
| City | PRINEVILLE |
| Zip Code | 97754 |
Please comment or provide details below to improve the information on CHARLES KEITH SANBORN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.