Provider Demographics
NPI:1750448130
Name:MANAGED HEALTH CARE OF OREGON I LLC
Entity Type:Organization
Organization Name:MANAGED HEALTH CARE OF OREGON I LLC
Other - Org Name:MANAGED HEALTHCARE OF OR LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:VORRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-357-8442
Mailing Address - Street 1:1825 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1939
Mailing Address - Country:US
Mailing Address - Phone:503-357-8442
Mailing Address - Fax:503-992-0722
Practice Address - Street 1:1825 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1939
Practice Address - Country:US
Practice Address - Phone:503-357-8442
Practice Address - Fax:503-992-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ORIP0001181CS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR034285Medicaid
2078292OtherPK
1181870001Medicare NSC