Provider Demographics
NPI:1740476241
Name:AWAKENINGS BY THE SEA
Entity type:Organization
Organization Name:AWAKENINGS BY THE SEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CADCII, NCACII
Authorized Official - Phone:503-738-7700
Mailing Address - Street 1:1325 N HOLLADAY DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-7131
Mailing Address - Country:US
Mailing Address - Phone:503-738-7700
Mailing Address - Fax:503-738-7733
Practice Address - Street 1:1325 N HOLLADAY DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7131
Practice Address - Country:US
Practice Address - Phone:503-738-7700
Practice Address - Fax:503-738-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR04-11-57U324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility