1841442001 NPI number — CLACKAMAS COUNTY

Table of content: (NPI 1841442001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841442001 NPI number — CLACKAMAS COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLACKAMAS COUNTY
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:
SANDY BEHAVIORAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1841442001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 KAEN RD
Provider Second Line Business Mailing Address:
SUITE 367
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-742-5300
Provider Business Mailing Address Fax Number:
503-655-8350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39740 PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97055-6412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-722-6937
Provider Business Practice Location Address Fax Number:
503-722-6850
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBSON
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR - INTERIM
Authorized Official Telephone Number:
503-201-1890

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: 022710 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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