1033489224 NPI number — NEIGHBORHOOD HEALTH CENTER

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 1033489224 NPI number — NEIGHBORHOOD HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORHOOD HEALTH CENTER
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:
1033489224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7320 SW HUNZIKER RD STE 300
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:
97223-2302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-941-3033
Provider Business Mailing Address Fax Number:
503-747-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
227 NW 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANBY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97013-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-416-4547
Provider Business Practice Location Address Fax Number:
503-416-4553
Provider Enumeration Date:
01/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
BLAIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO & COO
Authorized Official Telephone Number:
503-941-3033

Provider Taxonomy Codes

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

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

  • Identifier: 500670049 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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