1396734364 NPI number — NATIVE AMERICAN REHABILITATION ASSOCIATION, INC.

Table of content: (NPI 1396734364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396734364 NPI number — NATIVE AMERICAN REHABILITATION ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIVE AMERICAN REHABILITATION ASSOCIATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NATIVE AMERICAN REHABILITATION ASSOCIATION, INC.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396734364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1776 SW MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-224-1044
Provider Business Mailing Address Fax Number:
503-621-2235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 NE HANCOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-230-9875
Provider Business Practice Location Address Fax Number:
503-331-3441
Provider Enumeration Date:
10/20/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AYERS
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
JM
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
503-367-9089

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 126370 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2006165 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".