Provider Demographics
NPI:1568531952
Name:CASCADIA HEALTH
Entity Type:Organization
Organization Name:CASCADIA HEALTH
Other - Org Name:FAULKNER PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCALPINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-238-0769
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:503-552-6208
Practice Address - Street 1:13317 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3335
Practice Address - Country:US
Practice Address - Phone:503-760-9606
Practice Address - Fax:503-760-9609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR223347Medicaid
OR514779Medicaid
OR226398Medicaid