MEDICARE: CASCADIA BEHAVIORAL HEALTHCARE INC

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	261QM1300X	Multi-Specialty Clinic/Center

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	:	1679520787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASCADIA BEHAVIORAL HEALTHCARE INC

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:	503-552-6208

Provider Business Practice Location Address
First Line	:	3325 HAROLD DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-1339
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:	503-889-2599

Authorized Official
Title or Position	:	VP, HUMAN RESOURCES
Name	:	ENRIQUE SAMA
Credential	:
Telephone Number	:	503-963-7791

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	06/18/2008

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