Organization
LIBERTY HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON KELLEY (CEO)
(503) 540-0288
Entity
Organization
Contact information
Practice address
2685 4TH ST NE, SALEM, OR 97301-6548
(503) 540-0288
(503) 540-0293
Mailing address
2685 4TH ST NE, SALEM, OR 97301-6548
(503) 540-0288
(503) 540-0293
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067746000
BLUE CROSS BLUE SHIELD
OR
05
—
139463
—
OR
Enumeration date
11/21/2006
Last updated
10/27/2023
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