Provider Demographics
NPI:1417359282
Name:COMPLEX CARE SOLUTIONS
Entity Type:Organization
Organization Name:COMPLEX CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, MS, CNS
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLEE
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-251-3788
Mailing Address - Street 1:3426 NE 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3426 NE 78TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6574
Practice Address - Country:US
Practice Address - Phone:503-251-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7534216251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========Medicaid