Provider Demographics
NPI:1851698476
Name:COLUMBIA GORGE CHILDREN'S ADVOCACY CENTER
Entity Type:Organization
Organization Name:COLUMBIA GORGE CHILDREN'S ADVOCACY CENTER
Other - Org Name:SAFESPACE CHILDREN'S ADVOCACY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-436-2960
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-0030
Mailing Address - Country:US
Mailing Address - Phone:541-436-2960
Mailing Address - Fax:541-436-2961
Practice Address - Street 1:1625 WOODS CT STE 102
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2919
Practice Address - Country:US
Practice Address - Phone:541-436-2960
Practice Address - Fax:541-436-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare