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Organization

MODUS VIVENDI LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. OLGA V PARKER PHD (PROGRAM DIRECTOR)
(503) 781-9065
Entity
Organization

Contact information

Practice address
18428 SE PINE ST STE 105, PORTLAND, OR 97233-4873
(503) 781-9065
(503) 665-0160
Mailing address
PO BOX 66344, PORTLAND, OR 97290-6344
(503) 781-9065
(503) 761-6662

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CERIFICATE OF APPROV
OR

Other

Enumeration date
11/10/2009
Last updated
11/10/2009
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