Provider Demographics
NPI:1689473266
Name:NIBBUS COMBINED CARE LLC
Entity type:Organization
Organization Name:NIBBUS COMBINED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:458-226-5347
Mailing Address - Street 1:1175 E MAIN ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7457
Mailing Address - Country:US
Mailing Address - Phone:458-225-9993
Mailing Address - Fax:
Practice Address - Street 1:2240 TERREL DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-8140
Practice Address - Country:US
Practice Address - Phone:458-226-5347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIBBUS COMBINED CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness