Organization
PROVIDENCE HEALTH & SERVICES - OREGON
Active
Parent organization
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Other names
Providence Portland Medical Center - Child & Adolescent Psychiatric
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-4323
(503) 215-0297
Mailing address
PO BOX 3395, PORTLAND, OR 97208-3395
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
023981
OR
282N00000X
General Acute Care Hospital
023981
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023981
—
OR
05
—
500400190
—
OR
Enumeration date
07/07/2011
Last updated
05/07/2025
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