Provider Demographics
NPI:1447926829
Name:PIVOT BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:PIVOT BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DI DATO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:541-293-1325
Mailing Address - Street 1:1001 SW DISK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3754
Mailing Address - Country:US
Mailing Address - Phone:541-293-1325
Mailing Address - Fax:541-229-1314
Practice Address - Street 1:1001 SW DISK DR STE 250
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3754
Practice Address - Country:US
Practice Address - Phone:541-293-1325
Practice Address - Fax:541-229-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty