1104253079 NPI number — PARROTT CREEK CHILD & FAMILY SERVICES

Table of content: ERICA VASSELL (NPI 1336729946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104253079 NPI number — PARROTT CREEK CHILD & FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARROTT CREEK CHILD & FAMILY SERVICES
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:
1104253079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 MOLALLA AVE
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
OREGON CITY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97045-3788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-722-4110
Provider Business Mailing Address Fax Number:
503-655-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 MOLALLA AVE STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-722-4110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTS MANAGER
Authorized Official Telephone Number:
971-940-4773

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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