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VA SOUTHERN OREGON
NPI 1124198999
Substance Abuse Rehabilitation Facility in White City, OR

Active since November 09, 2006CLIA 38D0988128 · Accreditation
8495 CRATER LAKE HWY, WHITE CITY, OR 97503(541) 826-2111 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Va Southern Oregon NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VA SOUTHERN OREGON (NPI 1124198999) is a healthcare organization registered as a substance abuse rehabilitation facility in White City, Oregon and active in the NPI registry since November 2006. The organization holds an CLIA Accreditation certificate valid through May 22, 2032 and lists Wolfgang Laurence Agotta, Dual-diagnosis Therapist, as its authorized official.

NPPES Registry Identity

NPI1124198999
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameVA SOUTHERN OREGON
Location Address8495 CRATER LAKE HWYWhite City, OR 97503-3011
Mailing Address839 N Main StAshland, OR 97520-1713 · (541) 261-8349
Phone(541) 826-2111
Organization SubpartNo
Authorized OfficialWolfgang Laurence AgottaDual-diagnosis Therapist · (541) 826-2111
Enumeration DateNovember 9, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1124198999 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
8495 CRATER LAKE HWY, White City, OR 97503
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 38D0988128

VA Southern Oregon Rehabilitation Center & Clinic · White City, OR
Active · expires May 22, 2032
CLIA Number38D0988128
Laboratory TypeOther
Certificate Effective DateJune 21, 2001
Certificate Expiration DateMay 22, 2032
Laboratory DirectorEric Goranson
Laboratory Phone(540) 826-2111
Laboratory LocationVA Southern Oregon Rehabilitation Center & Clinic8495 Carter Lake Hwy Bldg 201, White City, OR 97503
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAURA BLACKBURN MSW
Social Worker (Clinical)
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
ADRIAN ANTHONY GARIBAY
Registered Nurse
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
KANDICE DRAAYER RN
Registered Nurse (Psychiatric/Mental Health, Adult)
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
WHITE CITY VAMC
General Acute Care Hospital
8495 CRATER LAKE HWY, VA SORCC
WHITE CITY, OR 97503
Jackson County (702) 341-3164
MR. KEVIN LEONARD WILLIAMS MSW, LCSW
Social Worker (Clinical)
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
DR. ERIC GUSTAFSON PHARM.D.
Pharmacist
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
LYN WAYNE SHEPERD
Registered Nurse
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111
JEAN EILEEN MOUNT
Nurse Practitioner (Adult Health)
8495 CRATER LAKE HWY
WHITE CITY, OR 97503
Jackson County (541) 826-2111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is VA Southern Oregon's NPI number?

The NPI number for VA Southern Oregon is 1124198999. It was assigned to this organization in the NPPES registry on November 9, 2006.

Where is VA Southern Oregon located?

VA Southern Oregon is located at 8495 Crater Lake Hwy, White City, OR 97503. The listed phone number is (541) 826-2111.

What is VA Southern Oregon's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does VA Southern Oregon hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 38D0988128) is associated with this NPI, valid through May 22, 2032. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for VA Southern Oregon was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.