Provider Demographics
NPI:1306383989
Name:BLACK PARENT INITIATIVE
Entity Type:Organization
Organization Name:BLACK PARENT INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:971-400-7977
Mailing Address - Street 1:2915 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3052
Mailing Address - Country:US
Mailing Address - Phone:503-284-8000
Mailing Address - Fax:
Practice Address - Street 1:2915 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3052
Practice Address - Country:US
Practice Address - Phone:503-284-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty