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1225 Ne 2nd Ave Portland OR 97232-2003 | |
| (503) 944-8000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1225 Ne 2nd Ave, Portland, Oregon |
| Authorized Official Name and Position | Sarah Jensen (VP FINANCE) |
| Authorized Official Contact | 5034155145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4037 Portland OR 97208-4037 Ph: (503) 413-4048 | 1225 Ne 2nd Ave Portland OR 97232-2003 Ph: (503) 944-8000 |
| NPI Number | 1003822487 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Medicare PECOS PAC ID | 4587573639 |
|---|---|
| Medicare Enrollment ID | O20080320000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003822487 | NPI | - | NPPES |
| 500708766 | Medicaid | OR | |
| 1000075 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 14-0056 (Oregon) | Primary |
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