NPI 1104219211

Allied Health Services

Organisation Substance Abuse Rehabilitation Facility Portland, OR

Practice location

Address: 324 NW Davis St, Portland, OR 97209-3925
Phone: (503) 226-2203
Fax: (503) 223-4231

Authorised official

Name: Michael Tierney
Title: Director
Phone: (503) 226-2203

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 140333 (OR)

Other Substance Abuse Rehabilitation Facility providers in Oregon →

Registry record

NPI: 1104219211
Entity type: Organization
NPI issued: 13 Mar 2015
Record last updated: 14 May 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.