| Old Town Recovery Center | |
|
33 Nw Broadway Portland OR 97209-3580 | |
| (503) 228-7134 | |
| (503) 501-5679 |
| Full Name | Old Town Recovery Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 33 Nw Broadway, Portland, Oregon |
| Authorized Official Name and Position | Andrew Mendenhall (PRESIDENT & CEO) |
| Authorized Official Contact | 5032941681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Town Recovery Center 232 Nw 6th Ave Portland OR 97209-3609 Ph: (503) 294-1681 | Old Town Recovery Center 33 Nw Broadway Portland OR 97209-3580 Ph: (503) 228-7134 |
| NPI Number | 1497044382 |
|---|---|
| Provider Enumeration Date | 03/31/2011 |
| Last Update Date | 05/24/2023 |
| Medicare PECOS PAC ID | 6103803259 |
|---|---|
| Medicare Enrollment ID | O20090504000618 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497044382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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