Provider Demographics
NPI:1760076392
Name:ACG GROUP
Entity Type:Organization
Organization Name:ACG GROUP
Other - Org Name:LILITH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-884-0842
Mailing Address - Street 1:511 SW 10TH AVE STE 904
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2710
Mailing Address - Country:US
Mailing Address - Phone:503-221-1870
Mailing Address - Fax:503-389-7945
Practice Address - Street 1:511 SW 10TH AVE STE 904
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2710
Practice Address - Country:US
Practice Address - Phone:503-221-1870
Practice Address - Fax:503-389-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center