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General NPI Number Information
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NPI Number | 1962836262
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Entity Type | Organization
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Legal Business Name | NEW VISION PROGRAMS OF OREGON
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 11576 SE 27TH AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-7719
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Country | US
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Telephone | 503-704-9478
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Fax | 503-855-3440
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Provider Business Mailing Address
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Address Line | 16172 NW KEVIN CT
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City | BEAVERTON
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State | OR
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Zip | 97006-7287
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Country | US
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Telephone | 503-704-9478
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Fax | 503-855-3440
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANDRE KARAM
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Credential |
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Telephone | 503-704-9478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 0118
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License Number State | OR
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