Organization
COLUMBIACARE SERVICES
Active
Other names
Centenial
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C BECKETT (EXECUTIVE DIRECTOE)
(541) 858-8170
Entity
Organization
Contact information
Practice address
15208 SE TIBBETTS ST, PORTLAND, OR 97236-2356
(503) 760-0959
(503) 761-0041
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
200012
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
518374
CENTENIAL SERVICE PMT
OR
Enumeration date
04/27/2011
Last updated
04/27/2011
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