Provider Demographics
NPI:1487015442
Name:CHRISTIAN APOSTOLIC COMMUNITY HOUSE
Entity Type:Organization
Organization Name:CHRISTIAN APOSTOLIC COMMUNITY HOUSE
Other - Org Name:CACH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWN/FOUNDER/MENTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISCHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRM, TRADHEALTH WKR
Authorized Official - Phone:971-282-6049
Mailing Address - Street 1:13232 SE STARK ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1573
Mailing Address - Country:US
Mailing Address - Phone:971-282-6049
Mailing Address - Fax:
Practice Address - Street 1:13232 SE STARK ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1573
Practice Address - Country:US
Practice Address - Phone:971-282-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW0298251K00000X
OR15-CRM-136251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare