Provider Demographics
NPI:1881637809
Name:CHRISTIECARE
Entity Type:Organization
Organization Name:CHRISTIECARE
Other - Org Name:CHRISTIE SCHOOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FINANCE AND ADMINISTRATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEIBELE
Authorized Official - Middle Name:
Authorized Official - Last Name:THERESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-675-2228
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MARYLHURST
Mailing Address - State:OR
Mailing Address - Zip Code:97036-0368
Mailing Address - Country:US
Mailing Address - Phone:503-635-3416
Mailing Address - Fax:503-697-6932
Practice Address - Street 1:2507 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:MARYLHURST
Practice Address - State:OR
Practice Address - Zip Code:97036
Practice Address - Country:US
Practice Address - Phone:503-635-3416
Practice Address - Fax:503-697-6932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0804X
OR322D00000X, 323P00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child