Provider Demographics
NPI:1821356536
Name:CLACKAMAS SERVICE CENTER
Entity Type:Organization
Organization Name:CLACKAMAS SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-799-3585
Mailing Address - Street 1:PO BOX 2620
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-2620
Mailing Address - Country:US
Mailing Address - Phone:503-771-7914
Mailing Address - Fax:503-771-8606
Practice Address - Street 1:8800 SE 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-9270
Practice Address - Country:US
Practice Address - Phone:503-771-7914
Practice Address - Fax:503-771-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10148063251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare