Organization
LUKEDORF
Active
Organization
LUKEDORF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MEGAN WIEGEL (HR)
(503) 726-3698
Entity
Organization
Contact information
Practice address
360 SW 6TH ST, GRESHAM, OR 97080-9475
(503) 726-3806
Mailing address
10313 69TH AVE, TIGARD, OR 97223
(503) 726-3806
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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