Provider Demographics
NPI:1396822763
Name:CASCADIA BEHAVIORAL HEALTHCARE INC
Entity Type:Organization
Organization Name:CASCADIA BEHAVIORAL HEALTHCARE INC
Other - Org Name:WOODBURN - BRIDGEWAY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-963-7791
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:503-552-6208
Practice Address - Street 1:399 YOUNG ST
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-4817
Practice Address - Country:US
Practice Address - Phone:503-981-5265
Practice Address - Fax:503-987-3736
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADIA BEHAVIORAL HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226398Medicaid
OR223347Medicaid
OR0000WCGZLMedicare PIN