Healthcare Provider Details

I. General information

NPI: 1922072487
Provider Name (Legal Business Name): EASTER SEALS OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MOYER LN NW
SALEM OR
97304-3822
US

IV. Provider business mailing address

5757 SW MACADAM AVE
PORTLAND OR
97239-3765
US

V. Phone/Fax

Practice location:
  • Phone: 503-370-8990
  • Fax: 503-363-4214
Mailing address:
  • Phone: 503-228-5108
  • Fax: 503-228-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. J DAVID CHEVEALLIER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 503-228-5108