MEDICARE: HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW

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
1	251V00000X	Voluntary or Charitable Agency		OR
2	251V00000X	Voluntary or Charitable Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	578168000	OTHER	OR	MAGELLAN HEALTH SERVICES
2	174029174029	OTHER	OR	LIFEWISE INSURANCE
3	J4525-01	OTHER	OR	PACIFIC SOURCE INSURANCE
4	089299000	OTHER	OR	REGENCE BLUE CROSS
5	6860-MA	OTHER	OR	PACIFICARE BEHAVIORAL HEA
6	A023	OTHER	OR	TRICARE

General Provider Information

NPI Number	:	1912025461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW

Provider Business Mailing Address
First Line	:	3107 GRAND AVENUE
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-2729
Country	:	US
Telephone Number	:	503-325-6754
Fax Number	:	503-325-1088

Provider Business Practice Location Address
First Line	:	3107 GRAND AVENUE
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-2729
Country	:	US
Telephone Number	:	503-325-6754
Fax Number	:	503-325-1088

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. MARY E LANGSTON
Credential	:	PHD, LPC, CADCIII
Telephone Number	:	503-325-6754

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/21/2022

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Directions to “HOPE HOUSE OF LUTHERAN COMMUNITY SERVICES NW ” Practice Location

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