Provider Demographics
NPI:1922175496
Name:POLK ADOLESCENT DAY TREATMENT CENTER INC
Entity Type:Organization
Organization Name:POLK ADOLESCENT DAY TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:503-623-5588
Mailing Address - Street 1:2200 E ELLENDALE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338
Mailing Address - Country:US
Mailing Address - Phone:503-623-5588
Mailing Address - Fax:503-623-4729
Practice Address - Street 1:2200 E ELLENDALE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338
Practice Address - Country:US
Practice Address - Phone:503-623-5588
Practice Address - Fax:503-623-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297982OtherPROVIDER NUMBER