Organization
PORTLAND PERITONEAL CENTER, INC.
Active
Other names
PORTLAND DIALYSIS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY GREEN (SECRETARY)
(562) 495-8075
Entity
Organization
Contact information
Practice address
10595 SE STARK ST, PORTLAND, OR 97216-2747
(503) 252-0019
(503) 252-0068
Mailing address
1 WORLD TRADE CTR, 2500, LONG BEACH, CA 90831-0002
(562) 495-8075
(562) 495-8076
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
394020
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121231
—
OR
Enumeration date
02/02/2006
Last updated
08/22/2020
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