Organization
KAISER PERMANENTE
Active
Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY DEAN GONZALES BS (MILIEU COUNSELOR)
(503) 571-0858
Entity
Organization
Contact information
Practice address
10180 SE SUNNYSIDE AVE 1ST FLOOR, WING A, BROOKSIDE CENTER RESIDENTIAL TREATMENT, CLACKAMAS, OR 97015-9303
(503) 571-0858
Mailing address
PO BOX 1366, OREGON CITY, OR 97045-0097
(503) 571-0858
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
—
—
Other
Enumeration date
04/29/2009
Last updated
04/29/2009
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