Provider Demographics
NPI:1578994646
Name:THE SALVATION ARMY
Entity Type:Organization
Organization Name:THE SALVATION ARMY
Other - Org Name:THE SALVATION ARMY WHITE SHIELD CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANDSMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:503-731-3961
Mailing Address - Street 1:PO BOX 10027
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97296-0027
Mailing Address - Country:US
Mailing Address - Phone:503-239-1248
Mailing Address - Fax:503-239-1252
Practice Address - Street 1:2640 NW ALEXANDRA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-1289
Practice Address - Country:US
Practice Address - Phone:503-239-1248
Practice Address - Fax:503-239-1252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty