Organization
CASCADIABHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA R JONES QMHA (CONUSLER 2)
(503) 402-8116
Entity
Organization
Contact information
Practice address
5009 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1915
(503) 402-8116
Mailing address
5009 NE KILLINGSWORTH ST, PORTLAND, OR 97218-1915
(503) 402-8116
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
101YM0800X
OR
Other
Enumeration date
01/30/2007
Last updated
08/22/2020
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