Provider Demographics
NPI:1639577398
Name:IRON TRIBE NETWORK
Entity Type:Organization
Organization Name:IRON TRIBE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:REICHERT
Authorized Official - Last Name:CUBBEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:CCEO
Authorized Official - Phone:503-754-3495
Mailing Address - Street 1:17763 SE 82ND DR STE D
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1822
Mailing Address - Country:US
Mailing Address - Phone:503-344-6710
Mailing Address - Fax:
Practice Address - Street 1:17763 SE 82ND DR STE D
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1822
Practice Address - Country:US
Practice Address - Phone:503-344-6710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A DAILY REPRIEVE CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health