Provider Demographics
NPI:1518212638
Name:CURITA FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:CURITA FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:503-255-3823
Mailing Address - Street 1:2442 SE 101ST AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3060
Mailing Address - Country:US
Mailing Address - Phone:503-255-3823
Mailing Address - Fax:503-255-3823
Practice Address - Street 1:2442 SE 101ST AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3060
Practice Address - Country:US
Practice Address - Phone:503-255-3823
Practice Address - Fax:503-255-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950143NP261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service