Providence Elder Place Portland

LBN: Providence Health System Oregon
Providence Elder Place Portland is an health care organization with primary practice located at 4540 Ne Glisan St , Portland OR 97213-2333. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Providence Health System Oregon can be contacted via phone (503) 215-3738, or through Keister, Donald M via phone (503) 215-3612.

Contact Information

Primary practice address
4540 Ne Glisan St Portland OR 97213-2333
Phone: (503) 215-3738
Fax: (503) 215-6942
Website:
Map and Directions
Authorized official contact:
Name: Keister, Donald M
Phone: (503) 215-3612

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X

Profile Details

NPI number 1023098118
LBN Legal business name Providence Health System Oregon
DBA Doing business as Providence Elder Place Portland
Authorized official Keister, Donald M
Entity Organization
Organization subpart 1 No
Enumeration date Jan 17th, 2006
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023098118 NPPES
Oregon MEDICAID 005673

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