Healthcare Provider Details

I. General information

NPI: 1700299013
Provider Name (Legal Business Name): CAROLINE WA PERRY RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 NE COCHRAN DR
GRESHAM OR
97030-4411
US

IV. Provider business mailing address

1565 NE COCHRAN DR
GRESHAM OR
97030-4411
US

V. Phone/Fax

Practice location:
  • Phone: 503-477-5660
  • Fax:
Mailing address:
  • Phone: 503-477-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: