Organization
PARKSIDE LIVING RTF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POONEH ENTEZARI (OWNER)
(503) 309-6202
Entity
Organization
Contact information
Practice address
1525 SW SHIRLEY ANN DR, MCMINNVILLE, OR 97128-7665
(503) 472-9603
Mailing address
139 N LOTUS BEACH DR, PORTLAND, OR 97217-8021
(503) 309-6202
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
OR
Other
Enumeration date
11/21/2008
Last updated
11/21/2008
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