Provider Demographics
NPI:1346420338
Name:DEPAUL TREATMENT CENTER
Entity Type:Organization
Organization Name:DEPAUL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:503-928-1570
Mailing Address - Street 1:4310 NE KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1404
Mailing Address - Country:US
Mailing Address - Phone:503-535-1181
Mailing Address - Fax:503-528-0800
Practice Address - Street 1:4310 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1404
Practice Address - Country:US
Practice Address - Phone:503-535-1181
Practice Address - Fax:503-528-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children