PROFESSIONAL THERAPUETIC COMMUNITY NETWORK (NPI# 1548636079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548636079 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL THERAPUETIC COMMUNITY NETWORK |
| Practice Address |
2905 River Rd S Salem OR 97302-9754 |
| Practice Telephone | 5033917175 |
| Mailing Telephone | 5033917175 |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |
| Authorized Official Name | JESSSE L WATSON (CEO) |
| Authorized Official Telephone | 5033917175 |
| Authorized Official Credential | MS.CCSOFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500657056 | 05 |
| Street Address |
2905 RIVER RD S |
| City | SALEM |
| State | OR |
| Zip Code | 97302-9754 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538341219 | Britney R Seitz | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2007-12-04 |
| 1396300497 | Patricia Joanne Myers | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2019-05-03 |
| 1699222471 | Mara Marie Walls | Social Worker | 2905 River Rd S, Salem, OR 97302-9754 | 2016-09-08 |
| 1609321769 | Liam Abraham | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2016-08-18 |
| 1043617988 | Cindy Webb | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2014-11-20 |
| 1801200969 | Nacole Cavette | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2014-06-17 |
| 1013321348 | Babak Zolfaghari-azar | Behavioral Analyst | 2905 River Rd S, Salem, OR 97302-9754 | 2014-06-14 |
| 1477967875 | Kirsten G Collins | Behavioral Analyst | 2905 River Rd S, Salem, OR 97302-9754 | 2014-06-13 |
| 1558798298 | Christa Lee Cummins | Counselor | 2905 River Rd S, Salem, OR 97302-9754 | 2013-09-26 |
| 1114268802 | Jeremy Wilson Kenney | Psychologist | 2905 River Rd S, Salem, OR 97302-9754 | 2013-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
| 1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
| 1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
| 1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
| 1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
| 1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
| 1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
| 1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
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| 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 |
|---|---|---|---|---|
| 1619097052 | Redemption, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 11780 Western Reserve Rd, Salem, OH 44460-7619 | 2007-03-30 |
| 1497205686 | Beacon Youth & Prevention Services | Residential Treatment Facility, Emotionally Disturbed Children | 3000 Market St Ne, Suite 528, Salem, OR 97301-1882 | 2016-10-11 |
| 1700265147 | David Pungercar | Residential Treatment Facility, Emotionally Disturbed Children | 4347 Sunnyview Rd. Ne, Salem, OR 97305 | 2015-05-19 |
| 1245487834 | Virginia Baptist Childrens Home and Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 860 Mount Vernon Ln, Salem, VA 24153-2700 | 2008-08-26 |
| 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 |
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| 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.