Provider Demographics
NPI:1558427955
Name:FRIENDSHIP HEALTH CENTER, INC
Entity Type:Organization
Organization Name:FRIENDSHIP HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-872-1185
Mailing Address - Street 1:3320 SE HOLGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3459
Mailing Address - Country:US
Mailing Address - Phone:503-231-1411
Mailing Address - Fax:503-239-1170
Practice Address - Street 1:3320 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3459
Practice Address - Country:US
Practice Address - Phone:503-231-1411
Practice Address - Fax:503-239-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR803189Medicaid
OR803189Medicaid