Basic Information
| Provider Information | |||||||||
| NPI: | 1417277021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DE PAUL TREATMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3007 | ||||||||
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| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035351150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4310 NE KILLINGSWORTH ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972181404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035351150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 06/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | KHALSA | ||||||||
| AuthorizedOfficialFirstName: | SHABD | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMISSIONS COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 5035351150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | B.A. PSYCHOLOGY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.