Provider Demographics
NPI:1104018522
Name:SILOAM INTERNATIONAL INC
Entity Type:Organization
Organization Name:SILOAM INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIR.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DRUG & ALCOHOL MA
Authorized Official - Phone:503-381-5881
Mailing Address - Street 1:732 SW 3RD AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2416
Mailing Address - Country:US
Mailing Address - Phone:503-381-5881
Mailing Address - Fax:503-283-1898
Practice Address - Street 1:732 SW 3RD AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2416
Practice Address - Country:US
Practice Address - Phone:503-381-5881
Practice Address - Fax:503-283-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health