Organization
NORTHSTAR IOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RYAN GLOCK (PARTNER)
(503) 888-8050
Entity
Organization
Contact information
Practice address
16100 NW CORNELL RD STE 220B, BEAVERTON, OR 97006-7334
(503) 878-8885
Mailing address
16100 NW CORNELL RD STE 220B, BEAVERTON, OR 97006-7334
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/09/2022
Last updated
12/09/2022
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