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NPI Code Detail

MEDICARE: CASCADIA BEHAVIORAL HEALTHCARE INC

MEDICARE: CASCADIA BEHAVIORAL HEALTHCARE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710064035
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASCADIA BEHAVIORAL HEALTHCARE INC
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-238-0769
Fax Number : 503-552-6208
Provider Business Practice Location Address
First Line : 2270 SE 39TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5916
Country : US
Telephone Number : 503-963-8337
Fax Number : 503-963-8365
Authorized Official
Title or Position : VP, HUMAN RESOURCES
Name : ENRIQUE SAMA
Credential :
Telephone Number : 503-963-7791
Provider Enumeration Date : 11/01/2006
Last Update Date : 06/13/2008

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Practice Location Address:
2270 SE CESAR E CHAVEZ BLVD
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1386760700 — MS. CASEY L GIBBS QMHA
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Directions to “CASCADIA BEHAVIORAL HEALTHCARE INC ” Practice Location

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