Provider Demographics
NPI:1679774418
Name:CHILDREN'S FARM HOME
Entity type:Organization
Organization Name:CHILDREN'S FARM HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CATS 1
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:STANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-965-0302
Mailing Address - Street 1:4163 NW WALNUT PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4163 NW WALNUT PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1036
Practice Address - Country:US
Practice Address - Phone:541-758-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility