Provider Demographics
NPI:1235474354
Name:DOUGLAS RESIDENT TRAINING FACILITIES, INC
Entity type:Organization
Organization Name:DOUGLAS RESIDENT TRAINING FACILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-679-6237
Mailing Address - Street 1:931 NW HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5136
Mailing Address - Country:US
Mailing Address - Phone:541-679-6237
Mailing Address - Fax:541-679-3943
Practice Address - Street 1:931 NW HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-5136
Practice Address - Country:US
Practice Address - Phone:541-679-6237
Practice Address - Fax:541-679-3943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDD2194315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities