Provider Demographics
NPI:1841318581
Name:DEPAUL YOUTH AND FAMILY
Entity type:Organization
Organization Name:DEPAUL YOUTH AND FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GIRLS PROGRAM SUPERVISIOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANAKO
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:CADCI QMHA
Authorized Official - Phone:503-535-1150
Mailing Address - Street 1:4310 NE KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1404
Mailing Address - Country:US
Mailing Address - Phone:503-535-1150
Mailing Address - Fax:
Practice Address - Street 1:4310 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1404
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children