MEDICARE: CAMERON CARE GARFIELD

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1922243815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMERON CARE GARFIELD

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	FAIRVIEW
State	:	OR
Zip	:	97024-0339
Country	:	US
Telephone Number	:	503-320-4764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3626 NE GARFIELD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2035
Country	:	US
Telephone Number	:	503-320-4764
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. COREY S CAMERON
Credential	:
Telephone Number	:	503-320-4764

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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