Provider Demographics
NPI:1720118813
Name:CASCADIABHC
Entity Type:Organization
Organization Name:CASCADIABHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL COUNCELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:NON-CREDENTIALED COU
Authorized Official - Phone:503-771-6061
Mailing Address - Street 1:3608 SE 40TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1769
Mailing Address - Country:US
Mailing Address - Phone:
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:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness