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NPI Code Detail

MEDICARE: PARKSIDE LIVING RTF

MEDICARE: PARKSIDE LIVING RTF
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
1320800000XMental Illness Community Based Residential Treatment FacilityOR

General Provider Information

NPI Number : 1447405147
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARKSIDE LIVING RTF
Provider Business Mailing Address
First Line : 139 N LOTUS BEACH DR
Second Line :
City : PORTLAND
State : OR
Zip : 97217-8021
Country : US
Telephone Number : 503-309-6202
Fax Number :
Provider Business Practice Location Address
First Line : 1525 SW SHIRLEY ANN DR
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-7665
Country : US
Telephone Number : 503-472-9603
Fax Number :
Authorized Official
Title or Position : OWNER
Name : POONEH ENTEZARI
Credential :
Telephone Number : 503-309-6202
Provider Enumeration Date : 11/21/2008
Last Update Date : 11/21/2008

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Directions to “PARKSIDE LIVING RTF ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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