| NPI | 1710286059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY THOMPSON Licensed Clinical Social Worker 503-575-0859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR 3662) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: OR 3662) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2011-03-25 |