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General NPI Number Information
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NPI Number | 1669856571
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Entity Type | Organization
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Legal Business Name | PORTLAND IOP, LLC
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 748 SE 181ST AVE
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City | PORTLAND
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State | OR
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Zip | 97233-4945
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Country | US
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Telephone | 503-825-7046
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Fax |
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Provider Business Mailing Address
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Address Line | 2675 NW THURMAN ST
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City | PORTLAND
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State | OR
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Zip | 97210-2202
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Country | US
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Telephone | 503-825-7046
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Fax | 503-432-8913
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ALIXAUNDREA CORRIN POLI
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Credential |
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Telephone | 360-969-4787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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