Provider Demographics
NPI:1265676605
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MILIEU COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:503-571-0858
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0097
Mailing Address - Country:US
Mailing Address - Phone:503-571-0858
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE AVE 1ST FLOOR, WING A
Practice Address - Street 2:BROOKSIDE CENTER RESIDENTIAL TREATMENT
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9303
Practice Address - Country:US
Practice Address - Phone:503-571-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital