Healthcare Provider Details

I. General information

NPI: 1093108367
Provider Name (Legal Business Name): MONUMENTAL VISIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 N HOLLAND ST
PORTLAND OR
97217-1522
US

IV. Provider business mailing address

226 N HOLLAND ST
PORTLAND OR
97217-1522
US

V. Phone/Fax

Practice location:
  • Phone: 503-935-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AARON BELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-935-3350