Provider Demographics
NPI:1689002859
Name:PORTLAND AREA RECOVERY SERVICES
Entity Type:Organization
Organization Name:PORTLAND AREA RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:971-300-5518
Mailing Address - Street 1:2425 SW 171ST PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4300
Mailing Address - Country:US
Mailing Address - Phone:971-300-5518
Mailing Address - Fax:
Practice Address - Street 1:1017 SW MORRISON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2635
Practice Address - Country:US
Practice Address - Phone:971-300-5518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health