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Organization
PROVIDENCE HEALTH SYSTEM OREGON
Active
Organization
PROVIDENCE HEALTH SYSTEM OREGON
Active
Other names
Providence Elder Place Portland
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4540 NE GLISAN ST, PORTLAND, OR 97213-2333
(503) 215-3738
(503) 215-6942
Mailing address
13007 NE GLISAN ST, PORTLAND, OR 97230-2545
(503) 215-6556
(503) 215-0685
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/17/2006
Last updated
05/16/2025
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