Healthcare Provider Details

I. General information

NPI: 1023007093
Provider Name (Legal Business Name): NATIVE AMERICAN REHABILITATION ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17645 NW SAINT HELENS RD
PORTLAND OR
97231-1729
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 503-621-1069
  • Fax: 503-621-0200
Mailing address:
  • Phone: 503-224-1044
  • Fax: 971-260-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number700032
License Number StateOR

VIII. Authorized Official

Name: MS. SARAH AYERS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 503-367-9089