MEDICARE: LUTHERAN COMMUNITY SERVICES NORTHWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		OR
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326056433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN COMMUNITY SERVICES NORTHWEST

Provider Business Mailing Address
First Line	:	605 SE CESAR E CHAVEZ BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-3216
Country	:	US
Telephone Number	:	503-231-7480
Fax Number	:	503-731-9574

Provider Business Practice Location Address
First Line	:	605 SE CESAR E CHAVEZ BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-3216
Country	:	US
Telephone Number	:	503-231-7480
Fax Number	:	503-731-9574

Authorized Official
Title or Position	:	DISTRICT DIRECTOR
Name	:	PETER VOGELAAR
Credential	:
Telephone Number	:	503-231-7480

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	05/16/2025

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