1013066901 NPI number — TREATMENT SERVICES NW LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013066901 NPI number — TREATMENT SERVICES NW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREATMENT SERVICES NW LLC
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:
1013066901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9370 SW GREENBURG RD
Provider Second Line Business Mailing Address:
#601
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-246-5238
Provider Business Mailing Address Fax Number:
503-246-0570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9370 SW GREENBURG RD
Provider Second Line Business Practice Location Address:
#601
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-246-5238
Provider Business Practice Location Address Fax Number:
503-246-0570
Provider Enumeration Date:
01/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COTTON
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
CODIRECTOR
Authorized Official Telephone Number:
503-246-5238

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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