Provider Demographics
NPI:1073888137
Name:CASCADIA HEALTH
Entity Type:Organization
Organization Name:CASCADIA HEALTH
Other - Org Name:PORTLAND HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCALPINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-238-0769
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:
Practice Address - Street 1:1035 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2154
Practice Address - Country:US
Practice Address - Phone:503-722-3877
Practice Address - Fax:503-387-5653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646792Medicaid