Provider Demographics
NPI:1821861659
Name:OREGON COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:OREGON COMMUNITY CARE LLC
Other - Org Name:OREGON COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSY.D
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-242-4194
Mailing Address - Street 1:80 SE MADISON ST STE 242
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4527
Mailing Address - Country:US
Mailing Address - Phone:971-242-4194
Mailing Address - Fax:
Practice Address - Street 1:80 SE MADISON ST STE 242
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4527
Practice Address - Country:US
Practice Address - Phone:443-585-0187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)