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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
LOUISE BAUSCHARD (EXECUTIVE DIRECTOR)
(503) 997-8041
Entity
Organization

Contact information

Practice address
254 NORTH 1ST AVE., HILLSBORO, OR 97124
(503) 997-8041
(503) 846-0709
Mailing address
254 NORTH FIRST AVE., HILLSBORO, OR 97124
(503) 997-8041

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
L2155SR
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
TWH0321
OR
Enumeration date
08/04/2015
Last updated
08/04/2015
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