IndividualActive
Jessica Hernandez
NPI 1336004233 · Emotionally Disturbed Childrens' Residential Treatment Facility · Corvallis, OR
Provider details
- NPI number
- 1336004233
- Entity type
- Individual
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Residential Treatment Facilities
Practice location
4400 Nw Walnut Blvd Apt 71
Corvallis, OR 97330-3298
Phone: (541) 740-0708
Approximate (ZIP-level) locationGet directions
Mailing address
4400 Nw Walnut Blvd Apt 71
Corvallis, OR 97330-3298
Registry dates
- Enumerated
- 2025-12-22
- Last updated
- 2025-12-22
- Certified
- 2025-12-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.