Organization
YOUTH VILLAGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAIN BOLAND MA (REGIONAL SUPERVISOR)
(503) 675-2266
Entity
Organization
Contact information
Practice address
2507 CHRISTIE DR., LAKE OSWEGO, OR 97034
(503) 635-3416
Mailing address
PO BOX 368, MARYLHURST, OR 97036-0368
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/14/2017
Last updated
02/14/2017
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