1912025461 NPI number — HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW

Table of content: (NPI 1912025461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912025461 NPI number — HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW
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:
Provider Other Organization Name Type Code:
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:
1912025461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3107 GRAND AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97103-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-325-6754
Provider Business Mailing Address Fax Number:
503-325-1088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3107 GRAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97103-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-325-6754
Provider Business Practice Location Address Fax Number:
503-325-1088
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANGSTON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
503-325-6754

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 578168000 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 174029174029 . This is a "LIFEWISE INSURANCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: J4525-01 . This is a "PACIFIC SOURCE INSURANCE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 089299000 . This is a "REGENCE BLUE CROSS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 6860-MA . This is a "PACIFICARE BEHAVIORAL HEA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: A023 . This is a "TRICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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