Organization
ACTIVE INDEPENDENCE OREGON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RILEY DEBOEST (DIRECTOR/OWNER)
(507) 219-0122
Entity
Organization
Contact information
Practice address
3929 NE 78TH AVE APT 12, PORTLAND, OR 97213-6400
(507) 219-0122
Mailing address
3929 NE 78TH AVE APT 12, PORTLAND, OR 97213-6400
(507) 219-0122
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
11/25/2024
Last updated
11/25/2024
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