| Heather Greene Llc | |
|
12555 Sw 1st St Beaverton OR 97005-0546 | |
| (971) 724-7393 | |
| Not Available |
| Full Name | Heather Greene Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12555 Sw 1st St, Beaverton, Oregon |
| Authorized Official Name and Position | Heather Greene (OWNER) |
| Authorized Official Contact | 9717247393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Greene Llc 18005 Sw Ewen Dr Beaverton OR 97003-3818 Ph: (971) 724-7393 | Heather Greene Llc 12555 Sw 1st St Beaverton OR 97005-0546 Ph: (971) 724-7393 |
| NPI Number | 1215463518 |
|---|---|
| Provider Enumeration Date | 05/04/2017 |
| Last Update Date | 05/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215463518 | NPI | - | NPPES |
| 1912204546 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | L4691 (Oregon) | Primary |
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