OrganizationActive
Blue Diamond Estates
NPI 1962090951 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Bandon, OR
Provider details
- NPI number
- 1962090951
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Mary Johnson, Qmha(541) 751-5040
Specialties & taxonomies
Residential Treatment Facilities
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
87326 Mctimmons Ln
Bandon, OR 97411-8285
Phone: (541) 217-4006
Fax: (541) 347-7555
Street-level locationGet directions
Mailing address
87326 Mctimmons Ln
Bandon, OR 97411-8285
Registry dates
- Enumerated
- 2021-01-05
- Last updated
- 2021-01-05
- Certified
- 2021-01-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.