Provider Demographics
NPI:1740425628
Name:CAMERON CARE BOISE
Entity Type:Organization
Organization Name:CAMERON CARE BOISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-320-4764
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97024-0339
Mailing Address - Country:US
Mailing Address - Phone:503-320-4764
Mailing Address - Fax:503-214-9787
Practice Address - Street 1:12657 SE BOISE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3723
Practice Address - Country:US
Practice Address - Phone:503-320-4764
Practice Address - Fax:503-214-9787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMERON CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness