# PROVIDENCE HEALTH SYSTEM OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Elder Place Portland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023098118
- **Authorized official:** MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 4540 NE GLISAN ST, PORTLAND, OR 97213-2333
- **Practice address phone:** (503) 215-3738
- **Practice address fax:** (503) 215-6942
- **Mailing address:** 13007 NE GLISAN ST, PORTLAND, OR 97230-2545
- **Mailing address phone:** (503) 215-6556
- **Mailing address fax:** (503) 215-0685

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/17/2006
- **Last updated:** 05/16/2025