Provider Demographics
NPI:1033607494
Name:HM-HU
Entity Type:Organization
Organization Name:HM-HU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-935-1513
Mailing Address - Street 1:4512 NE PORTLAND HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1363
Mailing Address - Country:US
Mailing Address - Phone:503-935-1513
Mailing Address - Fax:
Practice Address - Street 1:4512 NE PORTLAND HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1363
Practice Address - Country:US
Practice Address - Phone:503-935-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW1630175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW1630OtherADULT MENTAL HEALTH
ORTHW1630OtherADULT ADDICTION
ORTHW1630OtherPEER SERVICE
ORTHW1630Medicaid