Organization
OUTSIDE IN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI KELLEY (FISCAL MANAGER)
(503) 535-3882
Entity
Organization
Contact information
Practice address
11300 SE 23RD AVE, MILWAUKIE, OR 97222-7753
(503) 353-5847
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(503) 535-3800
(503) 223-6837
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1041C0700X
OR
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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