Organization
PORTLAND IOP, LLC
Active
Other names
Klean Gresham
Organization subpart
No
Provider details
NPI number
Authorized official
ALIXAUNDREA CORRIN POLI (OFFICE MANAGER)
(360) 969-4787
Entity
Organization
Contact information
Practice address
748 SE 181ST AVE, PORTLAND, OR 97233-4945
(503) 825-7046
Mailing address
2675 NW THURMAN ST, PORTLAND, OR 97210-2202
(503) 825-7046
(503) 432-8913
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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