Healthcare Provider Details

I. General information

NPI: 1851698476
Provider Name (Legal Business Name): COLUMBIA GORGE CHILDREN'S ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WASCO LOOP
HOOD RIVER OR
97031-1271
US

IV. Provider business mailing address

PO BOX 904
HOOD RIVER OR
97031-0030
US

V. Phone/Fax

Practice location:
  • Phone: 541-436-2960
  • Fax: 541-436-2961
Mailing address:
  • Phone: 541-436-2960
  • Fax: 541-436-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MAYRA RIVERA
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 541-436-2960