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General NPI Number Information
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NPI Number | 1033647201
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Entity Type | Organization
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Legal Business Name | CHITARI FOUNDATION
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4257
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Country | US
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Telephone | 503-400-9397
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Fax |
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Provider Business Mailing Address
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Address Line | 16144 SE HAPPY VALLEY TOWN CENTER DR STE 214
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-4257
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Country | US
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Telephone | 503-400-9397
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Fax |
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | DR. CHANTELLE BALDWIN
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Credential | DO ND
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Telephone | 503-400-9397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 00217
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License Number State | OR
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