# NORTHWEST WADE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Community Ambulance
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033231709
- **Authorized official:** MS. JUNITA JEAN KAUBLE EMD AND GENERAL MANA (GENERAL MANAGER AND EMERGENCY MEDIC)
- **Authorized official phone:** (503) 241-7283

## Contact information

- **Practice address:** 9807 SE ASH ST, PORTLAND, OR 97216
- **Practice address phone:** (503) 241-7283
- **Practice address fax:** (503) 246-2155
- **Mailing address:** PO BOX 16098, PORTLAND, OR 97292
- **Mailing address phone:** (503) 241-7283
- **Mailing address fax:** (503) 246-2155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 383936 | OR | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | 383936 | OR | — |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 09/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 149187 | — | OR |