Provider Demographics
NPI:1598917866
Name:KAISER PERMENENTE SUNNYSIDE MEDICAL CENTER
Entity Type:Organization
Organization Name:KAISER PERMENENTE SUNNYSIDE MEDICAL CENTER
Other - Org Name:BROOKSIDE ADDICTION MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:MILIEU COUNSELOR 1
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-702-5826
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-0513
Mailing Address - Country:US
Mailing Address - Phone:503-702-5826
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-702-5826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital