Provider Demographics
NPI:1326402652
Name:RIVER'S WAY COMMUNITY CLINIC
Entity Type:Organization
Organization Name:RIVER'S WAY COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-223-8188
Mailing Address - Street 1:2049 NW HOYT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1260
Mailing Address - Country:US
Mailing Address - Phone:503-223-8188
Mailing Address - Fax:503-227-7003
Practice Address - Street 1:2049 NW HOYT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1260
Practice Address - Country:US
Practice Address - Phone:503-223-8188
Practice Address - Fax:503-227-7003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCESS WORK INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health