Provider Demographics
NPI:1801121256
Name:MTN. RETREAT SECURED TRANSPORT
Entity type:Organization
Organization Name:MTN. RETREAT SECURED TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:RAPOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-666-9895
Mailing Address - Street 1:P.O. BOX 16157
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292
Mailing Address - Country:US
Mailing Address - Phone:503-666-9895
Mailing Address - Fax:503-666-8165
Practice Address - Street 1:929 NE 181ST AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230
Practice Address - Country:US
Practice Address - Phone:503-666-9895
Practice Address - Fax:503-666-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA343800000X
OR343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDHS128560OtherCHILD WELFARE
WA9046814Medicaid
OR116090Medicaid