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Organization
IMPACT NW
Active
Organization
IMPACT NW
Active
Other names
Portland Impact, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA LEE ADAMS (LTK PROJECT COORDINATOR)
(541) 227-8888
Entity
Organization
Contact information
Practice address
7211 SE 62ND AVE, PORTLAND, OR 97206
(503) 721-6776
(971) 254-8969
Mailing address
PO BOX 33530, PORTLAND, OR 97292-3530
(503) 294-7400
(503) 802-0046
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500721499
—
OR
Enumeration date
07/15/2010
Last updated
08/17/2017
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