# PROVIDENCE PORLAND MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Health System
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770776387
- **Authorized official:** MRS. TERRI LYNN EELLS (RN/NURSE PRACTITIONER STUDENT)
- **Authorized official phone:** 15032156150

## Contact information

- **Practice address:** 4805 NE GLISAN ST, PORTLAND, OR 97213-2933
- **Practice address phone:** (503) 215-1111
- **Mailing address:** 312 ENGLE AVE, MOLALLA, OR 97038-9138
- **Mailing address phone:** (150) 335-1019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 09000464RN | OR | Yes |

## Other

- **Enumeration date:** 08/27/2007
- **Last updated:** 08/27/2007