We Rise, Llc | |
3311 Ne Mlk Jr Blvd 104 Portland OR 97212-2086 | |
(503) 317-4240 | |
Not Available |
Full Name | We Rise, Llc |
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Speciality | Community/Behavioral Health |
Location | 3311 Ne Mlk Jr Blvd, Portland, Oregon |
Authorized Official Name and Position | Juanita Rene Tucker (CEO) |
Authorized Official Contact | 5033174240 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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We Rise, Llc 4216 Ne Rodney Ave Portland OR 97211-3428 Ph: (503) 317-4240 | We Rise, Llc 3311 Ne Mlk Jr Blvd 104 Portland OR 97212-2086 Ph: (503) 317-4240 |
NPI Number | 1922552363 |
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Provider Enumeration Date | 08/13/2016 |
Last Update Date | 08/13/2016 |
Medicare PECOS PAC ID | 3274892898 |
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Medicare Enrollment ID | O20180104002024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922552363 | NPI | - | NPPES |
500664189 | Medicaid | OR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | L4517 (Oregon) | Primary |
Provider Name | Juanita Rene Tucker |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1114092145 PECOS PAC ID: 6507092459 Enrollment ID: I20131122001671 |
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