MEDICARE: EMERSON HOUSE

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	311500000X	Alzheimer Center (Dementia Center)	1364583313	OR

General Provider Information

NPI Number	:	1730369349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERSON HOUSE

Provider Business Mailing Address
First Line	:	3577 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1561
Country	:	US
Telephone Number	:	503-234-8585
Fax Number	:	503-234-8535

Provider Business Practice Location Address
First Line	:	3577 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1561
Country	:	US
Telephone Number	:	503-234-8585
Fax Number	:	503-234-8535

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LINDA THOMAS
Credential	:
Telephone Number	:	503-234-8585

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	11/12/2007

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Directions to “EMERSON HOUSE ” Practice Location

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