Provider Demographics
NPI:1295881100
Name:THE BOYS & GIRLS AID SOCIETY OF OREGON
Entity type:Organization
Organization Name:THE BOYS & GIRLS AID SOCIETY OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT II
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-542-2340
Mailing Address - Street 1:018 SW BOUNDARY CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3939
Mailing Address - Country:US
Mailing Address - Phone:503-222-9661
Mailing Address - Fax:503-224-5960
Practice Address - Street 1:018 SW BOUNDARY CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3939
Practice Address - Country:US
Practice Address - Phone:503-222-9661
Practice Address - Fax:503-224-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017889OtherOMAP