Provider Demographics
NPI:1053559765
Name:PELTON PROJECT, INC.
Entity type:Organization
Organization Name:PELTON PROJECT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-689-4866
Mailing Address - Street 1:PO BOX 21748
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-1748
Mailing Address - Country:US
Mailing Address - Phone:541-760-7851
Mailing Address - Fax:503-304-2224
Practice Address - Street 1:714 LOST LN N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-6335
Practice Address - Country:US
Practice Address - Phone:503-463-6499
Practice Address - Fax:503-304-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health