Provider Demographics
NPI:1073699013
Name:KARTINI INTENSIVE OUTPATIENT PROGRAM
Entity Type:Organization
Organization Name:KARTINI INTENSIVE OUTPATIENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMIROW
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:503-249-8851
Mailing Address - Street 1:2800 N. VANCOUVER AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1634
Mailing Address - Country:US
Mailing Address - Phone:503-249-8851
Mailing Address - Fax:503-282-3409
Practice Address - Street 1:2800 N. VANCOUVER AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1634
Practice Address - Country:US
Practice Address - Phone:503-249-8851
Practice Address - Fax:503-282-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNON-NUMBERED CERTIFI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR26624890OtherDOMESTIC LLC
ORNON-NUMBERED CERTIFIOtherNON-INPATIENT MH FACILITY