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General NPI Number Information
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NPI Number | 1902504210
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Entity Type | Organization
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Legal Business Name | NEW LIFE EVANGELICAL MINISTRIES
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 519 SW 3RD AVE STE 800
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City | PORTLAND
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State | OR
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Zip | 97204-2553
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Country | US
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Telephone | 612-328-4819
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Fax | 763-762-6537
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Provider Business Mailing Address
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Address Line | 519 SW 3RD AVE STE 800
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City | PORTLAND
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State | OR
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Zip | 97204-2553
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Country | US
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Telephone | 612-328-4819
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Fax | 763-762-6537
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. CHRISTIANA GREENE
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Credential |
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Telephone | 612-328-4819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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