MEDICARE: ALTERNATIVE SERVICES OREOGN, 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	8203	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8203	OTHER	OR	LICENSE

General Provider Information

NPI Number	:	1811064447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVE SERVICES OREOGN, INC

Provider Business Mailing Address
First Line	:	11830 KERR PKWY
Second Line	:	SUITE 210
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-1249
Country	:	US
Telephone Number	:	503-977-2262
Fax Number	:	503-977-2301

Provider Business Practice Location Address
First Line	:	11830 KERR PKWY
Second Line	:	SUITE 210
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-1249
Country	:	US
Telephone Number	:	503-977-2262
Fax Number	:	503-977-2301

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. PATRICIA JOYCE ALLEN-SLEEMAN
Credential	:
Telephone Number	:	503-977-2262

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/22/2020

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