Provider Demographics
NPI:1558689653
Name:PROVIDENCE HEALTH & SERVICES-OREGON
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH & SERVICES-OREGON
Other - Org Name:PROVIDENCE CHILD CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, NHA, JD
Authorized Official - Phone:503-215-2413
Mailing Address - Street 1:830 NE 47TH AVE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2212
Mailing Address - Country:US
Mailing Address - Phone:503-215-4483
Mailing Address - Fax:503-215-0660
Practice Address - Street 1:830 NE 47TH AVE
Practice Address - Street 2:ATTN: FINANCE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2212
Practice Address - Country:US
Practice Address - Phone:503-215-4483
Practice Address - Fax:503-215-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty