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Organization
PROVIDENCE HEALTH & SERVICES-OREGON
Active
Organization
PROVIDENCE HEALTH & SERVICES-OREGON
Active
Other names
Providence Child Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 215-2400
(503) 215-0660
Mailing address
830 NE 47TH AVE, ATTN: FINANCE, PORTLAND, OR 97213-2212
(503) 215-2400
(503) 215-0660
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
1700250565
OR
3140N1450X
Pediatric Skilled Nursing Facility
1035453259
OR
385HR2065X
Child Physical Disabilities Respite Care
1035453259
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1035453259
DEPT OF HUMAN SVCS
OR
05
—
4570701
—
WA
05
—
807297
—
OR
Enumeration date
10/20/2006
Last updated
05/15/2025
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