1457308587 NPI number — CASCADIA BEHAVIORAL HEALTHCARE, INC

Table of content: (NPI 1457308587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457308587 NPI number — CASCADIA BEHAVIORAL HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADIA BEHAVIORAL HEALTHCARE, INC
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:
6
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:
1457308587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8459
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:
97207-8459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-238-0769
Provider Business Mailing Address Fax Number:
503-552-6208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 SW 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-238-0769
Provider Business Practice Location Address Fax Number:
503-889-2599
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAMA
Authorized Official First Name:
ENRIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, HUMAN RESOURCES
Authorized Official Telephone Number:
503-963-7791

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 226398 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223347 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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