Healthcare Provider Details

I. General information

NPI: 1437482916
Provider Name (Legal Business Name): PARTNERSHIPS IN COMMUNITY LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAIN ST E
MONMOUTH OR
97361-2335
US

IV. Provider business mailing address

PO BOX 129
MONMOUTH OR
97361-0129
US

V. Phone/Fax

Practice location:
  • Phone: 503-838-2403
  • Fax: 503-838-5815
Mailing address:
  • Phone: 503-838-2403
  • Fax: 503-838-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ZELLEE ALLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-838-2403