Provider Demographics
NPI:1891165833
Name:TERWILLIGER PLAZA, INC.
Entity Type:Organization
Organization Name:TERWILLIGER PLAZA, INC.
Other - Org Name:ALLY BY TERWILLIGER PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-299-1225
Mailing Address - Street 1:2545 SW TERWILLIGER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6302
Mailing Address - Country:US
Mailing Address - Phone:503-808-7802
Mailing Address - Fax:503-808-7804
Practice Address - Street 1:2545 SW TERWILLIGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6302
Practice Address - Country:US
Practice Address - Phone:503-808-7802
Practice Address - Fax:503-808-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152213253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care