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NPI Code Detail

MEDICARE: CASCADIABEHAVIORAL HEALTHCARE

MEDICARE: CASCADIABEHAVIORAL HEALTHCARE
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
1323P00000XPsychiatric Residential Treatment Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112110OTHERORCOMPANY

General Provider Information

NPI Number : 1700932928
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASCADIABEHAVIORAL HEALTHCARE
Provider Business Mailing Address
First Line : 7511 SE HENRY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-6445
Country : US
Telephone Number : 503-771-6061
Fax Number :
Provider Business Practice Location Address
First Line : 7511 SE HENRY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-6445
Country : US
Telephone Number : 503-771-6061
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : CORDELIA KOLAR
Credential :
Telephone Number : 503-771-6061
Provider Enumeration Date : 01/29/2007
Last Update Date : 08/22/2020

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Directions to “CASCADIABEHAVIORAL HEALTHCARE ” Practice Location

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