Organization
OUTSIDE IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICKA YOUNG (REVENUE CYCLE MANAGER)
(503) 535-3892
Entity
Organization
Contact information
Practice address
14355 N BYBEE LAKE CT, PORTLAND, OR 97203-6495
(503) 535-3800
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 535-3800
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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