PENDLETON ACADMIES (NPI# 1417991258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417991258 |
| Entity Type | Organization |
| Organization Name | PENDLETON ACADMIES |
| Other Organization Name | EASTERN OREGON CHILDREN'S MULTI-TREATMENT CENTER |
| Practice Address |
622 Airport Rd Pendleton OR 97801-4598 |
| Practice Telephone | 5412760057 |
| Practice Fax Number | 5412761704 |
| Mailing Telephone | 5412760057 |
| Mailing Fax Number | 5412761704 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2008-11-21 |
| Authorized Official Name | MR. P. TERRY EDVALSON (INTERIM EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5419667810 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 385HR2055X |
Respite Care Specialization: Respite Care, Mental Illness, Child |
OR | Respite Care Facility | |
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | OR | Residential Treatment Facilities | |
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | OR | Residential Treatment Facilities | |
| N | 251S00000X | Community/Behavioral Health | OR | Agencies | |
| N | 251B00000X | Case Management | OR | Agencies | |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
OR | Behavioral Health & Social Service Providers | |
| N | 103T00000X | Psychologist | OR | Behavioral Health & Social Service Providers | |
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
OR | Behavioral Health & Social Service Providers | |
| N | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities | ||
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities | ||
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 103TC1900X |
Psychologist Specialization: Counseling |
OR | Behavioral Health & Social Service Providers | |
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | OR | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 312048 | 05 | |
| OR | PCG023 | 05 | |
| OR | 312040 | 05 | |
| OR | 313437 | 05 | |
| OR | 312041 | 05 | |
| OR | 312064 | 05 | |
| OR | 182229 | 05 | |
| OR | 313205 | 05 | |
| OR | S20475 | 05 | |
| OR | 312056 | 05 |
| Other Name | Type Code |
|---|---|
| Eastern Oregon Children's Multi-Treatment Center | Former Legal Business Name - Organization |
| Street Address |
622 AIRPORT RD |
| City | PENDLETON |
| State | OR |
| Zip Code | 97801-4598 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245428705 | Leonard Wayne Lyons | Student in an Organized Health Care Education/Training Program | 622 Airport Rd, Pendleton, OR 97801-4598 | 2007-10-10 |
| 1780871236 | Roderick Edward Theis II | Counselor | 622 Airport Rd, Pendleton, OR 97801-4598 | 2007-09-28 |
| 1184811655 | Yvette Antonia Wart | Registered Nurse | 622 Airport Rd, Pendleton, OR 97801-4598 | 2007-09-28 |
| 1720275365 | Diane Kathleen Cort-wagner | Nurse Practitioner | 622 Airport Rd, Pendleton, OR 97801-4598 | 2007-09-27 |
| 1821284852 | Vince Charles Brunning | Counselor | 622 Airport Rd, Pendleton, OR 97801-4598 | 2007-09-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720637119 | Yvonne Walker | Technician | 821 Se 9th St, Pendleton, OR 97801 | 2019-09-09 |
| 1083262703 | Praxis Medical Group Inc | Family Medicine | 2450 Sw Perkins Avenue, Pendleton, OR 97801 | 2019-08-27 |
| 1255826012 | Cosmas Chukwuemeka Nwerem Jr. | Pharmacist | 1900 Sw Court Place, Pendleton, OR 97801 | 2018-06-25 |
| 1689166811 | Helene Danielle Kuhn | Counselor | 4700 Nw Pioneer Pl, Pendleton, OR 97801 | 2018-06-04 |
| 1801302849 | Shawna L. All | Massage Therapist | 24 Se Emigrant Ave., Pendleton, OR 97801 | 2017-12-27 |
| 1033649256 | Sean Collins | Pharmacist | 203 Sw 20th St, Pendleton, OR 97801 | 2017-06-20 |
| 1073974796 | Channon M Baker | Peer Specialist | 7525 Westgate Bldg #2, Pendleton Creek Crisis Stabilization Unit, Pendleton, OR 97801 | 2016-03-08 |
| 1689034357 | Carre Biegel | Counselor | 17 Sw Frazer St, Ste 282, Pendleton, OR 97801 | 2016-02-24 |
| 1073995429 | Jessica Suzanne Pedersen | Massage Therapist | 812 Nw 12th St, Pendleton, OR 97801 | 2015-06-22 |
| 1861736373 | Christina Northern Northerhn | Social Worker | 331 Se 2nd Street, Pendleton, OR 97801 | 2012-11-21 |
| Find all providers in zip 97801 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811541568 | Dragonfly Programs, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 505 N 9th St, Klamath Falls, OR 97601-2876 | 2019-07-31 |
| 1740844984 | Brigacare, Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 15703 Sw Whetstone Way, Sherwood, OR 97140-8895 | 2019-04-23 |
| 1275085128 | Northwest Youth Discovery | Residential Treatment Facility, Emotionally Disturbed Children | 61850 Dobbin Rd, Bend, OR 97702-9536 | 2016-10-26 |
| 1427414895 | Polk Youth Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 175 Ne Kings Valley Hwy Ste A, Dallas, OR 97338-1787 | 2016-01-14 |
| 1083070361 | Oregon 180 | Residential Treatment Facility, Emotionally Disturbed Children | 725 W 14th St, Medford, OR 97501-3429 | 2016-01-03 |
| 1013395953 | Bridges Academy Corp | Residential Treatment Facility, Emotionally Disturbed Children | 67030 Gist Rd, Bend, OR 97701-9209 | 2015-05-12 |
| 1336565993 | Northwest Youth Discovery | Residential Treatment Facility, Emotionally Disturbed Children | 9 Nw 15th St, Bend, OR 97701-3102 | 2014-03-06 |
| 1528499696 | Klamath Lake County Youth Ranch | Residential Treatment Facility, Emotionally Disturbed Children | 5800 Happy Hollow Ln, Bonanza, OR 97623-7714 | 2013-11-27 |
| 1487082681 | Yamhill County Juvenile Department | Residential Treatment Facility, Emotionally Disturbed Children | 535 E 5th St, Mcminnville, OR 97128-4504 | 2013-10-24 |
| 1154758266 | Youth Guidance Association | Residential Treatment Facility, Emotionally Disturbed Children | 2730 Ne Flanders St, Portland, OR 97232-3160 | 2013-10-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PENDLETON ACADMIES.
| 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.