Provider Demographics
NPI:1760717078
Name:EEA COMPANY
Entity Type:Organization
Organization Name:EEA COMPANY
Other - Org Name:COLUMBIA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DNS
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:VAN ORTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-543-7131
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-1068
Mailing Address - Country:US
Mailing Address - Phone:503-543-7131
Mailing Address - Fax:503-543-5220
Practice Address - Street 1:33910 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3309
Practice Address - Country:US
Practice Address - Phone:503-543-7131
Practice Address - Fax:503-543-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1672725855313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800565Medicaid