Healthcare Provider Details

I. General information

NPI: 1669849212
Provider Name (Legal Business Name): AVA CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NW AVA AVE
GRESHAM OR
97030-7019
US

IV. Provider business mailing address

75 NW AVA AVE
GRESHAM OR
97030-7019
US

V. Phone/Fax

Practice location:
  • Phone: 503-680-5285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EDGAR HEISSLER
Title or Position: PRESIDENT
Credential:
Phone: 503-680-5285