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General NPI Number Information
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NPI Number | 1558733527
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Entity Type | Organization
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Legal Business Name | ARISE MENTORS, LLP
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 5676 SE GARNET WAY
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City | MILWAUKIE
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State | OR
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Zip | 97267-6252
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Country | US
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Telephone | 503-893-5353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 709
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City | CLACKAMAS
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State | OR
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Zip | 97015-0709
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Country | US
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Telephone | 503-893-5353
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | STEPHEN REX GOODE
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Credential | B.S.W.
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Telephone | 503-893-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | DPO1413
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License Number State | OR
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