Organization · Type 2 NPI

La Pine Ktc, LLC

Substance Abuse Rehabilitation Facility · La Pine, OR

NPI number 1700258258 Active

Practice location

16161 Burgess Rd
La Pine, OR 97739-9533

Fax (503) 432-8913

Specialties and licenses

Taxonomy	Code	License
Substance Abuse Rehabilitation Facility Primary	324500000X	None listed

Substance Abuse Rehabilitation Facility: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

NPI record

NPI: 1700258258
Entity type: Organization (Type 2)
Issued: Oct 23, 2015
Last updated: Oct 23, 2015
Status: Active
Subpart: Yes of White Rabbit Partners

Other names

<unavail>
Klean la Pine · doing business as

Authorized official

Milton Parham
Chief Business Development Officer
(509) 668-8008

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1700258258

La Pine Ktc, LLC's National Provider Identifier is 1700258258, issued on Oct 23, 2015. The primary taxonomy on file is Substance Abuse Rehabilitation Facility (324500000X), and the practice location is in La Pine, OR. The record was last updated on Oct 23, 2015.