| Modus Vivendi Llc | |
|
18428 Se Pine St Ste 105 Portland OR 97233-4873 | |
| (503) 781-9065 | |
| (503) 665-0160 |
| Full Name | Modus Vivendi Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 18428 Se Pine St Ste 105, Portland, Oregon |
| Authorized Official Name and Position | Olga V Parker (PROGRAM DIRECTOR) |
| Authorized Official Contact | 5037819065 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modus Vivendi Llc Po Box 66344 Portland OR 97290-6344 Ph: (503) 781-9065 | Modus Vivendi Llc 18428 Se Pine St Ste 105 Portland OR 97233-4873 Ph: (503) 781-9065 |
| NPI Number | 1932436037 |
|---|---|
| Provider Enumeration Date | 11/10/2009 |
| Last Update Date | 11/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932436037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CERIFICATE OF APPROV (Oregon) | Primary |
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