# GLADSTONE COMMUNITY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063713717
- **Authorized official:** HANNAH E TYLER (R.N.)
- **Authorized official phone:** (503) 850-4472

## Contact information

- **Practice address:** 18911 PORTLAND AVE, GLADSTONE, OR 97027-1630
- **Practice address phone:** (503) 850-4472
- **Practice address fax:** (503) 850-4473
- **Mailing address:** 18911 PORTLAND AVE, GLADSTONE, OR 97027-1630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | 200243005RN | OR | Yes |

## Other

- **Enumeration date:** 11/11/2010
- **Last updated:** 11/11/2010