Provider Demographics
NPI:1164793469
Name:NEIGHBORHOOD HEALTH CENTER
Entity Type:Organization
Organization Name:NEIGHBORHOOD HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BLAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:503-941-3033
Mailing Address - Street 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-941-3033
Mailing Address - Fax:503-747-7013
Practice Address - Street 1:10690 NE CORNELL RD STE 220
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9224
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:503-848-5863
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIGHBORHOOD HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QF0400X, 261QF0400X, 261QF0400X
208000000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500670049Medicaid