Provider Demographics
NPI:1700932928
Name:CASCADIABEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:CASCADIABEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORDELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-771-6061
Mailing Address - Street 1:7511 SE HENRY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6445
Mailing Address - Country:US
Mailing Address - Phone:503-771-6061
Mailing Address - Fax:
Practice Address - Street 1:7511 SE HENRY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6445
Practice Address - Country:US
Practice Address - Phone:503-771-6061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR12110OtherCOMPANY