Provider Demographics
NPI:1518405091
Name:THE CITY OF NEWPORT 60 PLUS ACTIVITY CENTER
Entity Type:Organization
Organization Name:THE CITY OF NEWPORT 60 PLUS ACTIVITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARKS & REC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PROTIVA
Authorized Official - Suffix:
Authorized Official - Credentials:CPRC
Authorized Official - Phone:541-265-4855
Mailing Address - Street 1:20 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365
Mailing Address - Country:US
Mailing Address - Phone:541-574-5459
Mailing Address - Fax:
Practice Address - Street 1:20 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365
Practice Address - Country:US
Practice Address - Phone:541-574-0459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251V00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local