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General NPI Number Information
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NPI Number | 1194282806
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Entity Type | Organization
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Legal Business Name | OREGON ST. MARTIN CHARITIES ORG
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 5239 SE WOODSTOCK BLVD
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City | PORTLAND
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State | OR
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Zip | 97206-6822
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Country | US
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Telephone | 503-539-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 SE 74TH AVE
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City | PORTLAND
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State | OR
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Zip | 97206-2433
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Country | US
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Telephone | 871-501-7727
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AGNES STURGEON
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Credential |
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Telephone | 176-092-7478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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