Healthcare Provider Details

I. General information

NPI: 1043647886
Provider Name (Legal Business Name): ADVANCE TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18210 E BURNSIDE ST SUITE A
PORTLAND OR
97233-5343
US

IV. Provider business mailing address

18210 E BURNSIDE ST SUITE A
PORTLAND OR
97233-5343
US

V. Phone/Fax

Practice location:
  • Phone: 503-766-2582
  • Fax: 503-465-0165
Mailing address:
  • Phone: 503-766-2582
  • Fax: 503-465-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number073
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number073
License Number StateOR

VIII. Authorized Official

Name: MR. RAMIRO ALBARRAN
Title or Position: DIRECTOR
Credential: CADC I
Phone: 503-766-2582