# PROVIDENCE HEALTH & SERVICES-OREGON

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Elder At Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811384423
- **Authorized official:** MARK L METCALF (DIRECTOR OF FINANCE)
- **Authorized official phone:** (503) 215-5491

## Contact information

- **Practice address:** 4900 NE GLISAN ST, PORTLAND, OR 97213-2936
- **Practice address phone:** (503) 215-0750
- **Mailing address:** PO BOX 3158, PORTLAND, OR 97208-3158
- **Mailing address phone:** (503) 215-6494
- **Mailing address fax:** (503) 215-6644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | OR | — |
| 261Q00000X | Clinic/Center | — | OR | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | OR | Yes |

## Other

- **Enumeration date:** 04/21/2015
- **Last updated:** 04/21/2015