# WEST LINN CLEMENTINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clementine Portland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023562147
- **Authorized official:** MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (305) 663-1876

## Contact information

- **Practice address:** 1148 ROSEMONT RD, WEST LINN, OR 97068-9235
- **Practice address phone:** (971) 249-8448
- **Practice address fax:** (503) 305-7100
- **Mailing address:** 6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
- **Mailing address phone:** (305) 663-1876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | OR | Yes |

## Other

- **Enumeration date:** 08/05/2016
- **Last updated:** 03/04/2020