Provider Demographics
NPI:1356574412
Name:MULTIPLE SCLEROSIS SOCIETY OF PORTLAND OREGON, INC
Entity type:Organization
Organization Name:MULTIPLE SCLEROSIS SOCIETY OF PORTLAND OREGON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-297-9544
Mailing Address - Street 1:2901 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3205
Mailing Address - Country:US
Mailing Address - Phone:503-297-9544
Mailing Address - Fax:503-297-6264
Practice Address - Street 1:2901 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3205
Practice Address - Country:US
Practice Address - Phone:503-297-9544
Practice Address - Fax:503-297-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care