Healthcare Provider Details

I. General information

NPI: 1639863004
Provider Name (Legal Business Name): ST GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 SW ARCTIC DR
BEAVERTON OR
97005-9404
US

IV. Provider business mailing address

6020 SW ARCTIC DR
BEAVERTON OR
97005-9404
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-1575
  • Fax: 503-626-7188
Mailing address:
  • Phone: 503-641-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIA POPOVA
Title or Position: HEAD OF THE BOARD OF DIRECTORS
Credential:
Phone: 917-972-9854