Provider Demographics
NPI:1043647886
Name:ADVANCE TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCE TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBARRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CADC I
Authorized Official - Phone:503-766-2582
Mailing Address - Street 1:18210 E BURNSIDE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5343
Mailing Address - Country:US
Mailing Address - Phone:503-766-2582
Mailing Address - Fax:503-465-0165
Practice Address - Street 1:18210 E BURNSIDE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5343
Practice Address - Country:US
Practice Address - Phone:503-766-2582
Practice Address - Fax:503-465-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR073251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health