| NPI | 1023098118 |
|---|---|
| Doing Business As | PROVIDENCE ELDER PLACE PORTLAND |
| Entity Type | Organization |
| Authorized Contact | DONALD M KEISTER Executive Director 503-215-3612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2020-08-22 |