Provider Demographics
NPI:1881728087
Name:KINSHIP HOUSE
Entity type:Organization
Organization Name:KINSHIP HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETHEL
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:LEVAD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:503-460-2796
Mailing Address - Street 1:1823 NE 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3907
Mailing Address - Country:US
Mailing Address - Phone:503-460-2796
Mailing Address - Fax:503-460-3750
Practice Address - Street 1:1823 NE 8TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3907
Practice Address - Country:US
Practice Address - Phone:503-460-2796
Practice Address - Fax:503-460-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR210418Medicaid