Organization
IMPACT NW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ADAMS (LTK PROJECT COORDINATOR)
(541) 227-8888
Entity
Organization
Contact information
Practice address
7211 SE 62ND AVE, PORTLAND, OR 97206-7564
(503) 489-7034
Mailing address
PO BOX 33530, PORTLAND, OR 97292-3530
(503) 294-7400
(503) 802-0046
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500721499
—
OR
Enumeration date
02/06/2017
Last updated
03/17/2018
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