Provider Demographics
NPI:1912390956
Name:CRC ALLIED HELATH
Entity Type:Organization
Organization Name:CRC ALLIED HELATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-226-2203
Mailing Address - Street 1:808 SW ALDER ST
Mailing Address - Street 2:#300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3133
Mailing Address - Country:US
Mailing Address - Phone:503-226-2203
Mailing Address - Fax:503-223-4231
Practice Address - Street 1:808 SW ALDER ST
Practice Address - Street 2:#300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3133
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:503-223-4231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRC ALLIED HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness