Organization
OUTSIDE IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER REPPETO (EXECUTIVE DIRECTOR)
(503) 535-3860
Entity
Organization
Contact information
Practice address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 535-3803
(503) 223-6837
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 535-3803
(503) 223-6837
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181599
—
OR
Enumeration date
06/06/2006
Last updated
10/08/2025
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