PROVIDENCE HEALTH & SERVICES - OREGON (NPI# 1104113380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104113380 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES - OREGON |
| Other Organization Name | PROVIDENCE PORTLAND MEDICAL CENTER - CHILD & ADOLESCENT PSYCHIATRIC |
| Practice Address |
4805 Ne Glisan St Portland OR 97213-2933 |
| Mailing Address |
Po Box 3395 Portland OR 97208-3395 |
| Practice Telephone | 5032154323 |
| Practice Fax Number | 5032150297 |
| Mailing Telephone | 5032154323 |
| Mailing Fax Number | 5032150297 |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-10-31 |
| Authorized Official Name | MS. KATHLEEN DOWLING (COO) |
| Authorized Official Telephone | 5032154323 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES - WASHINGTON |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | 023981 | OR | Hospitals |
| Y | 273R00000X | Psychiatric Unit | 023981 | OR | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500400190 | 05 | |
| OR | 023981 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Portland Medical Center - Child & Adolescent Psychiatric | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922481456 | Providence Health & Services - Oregon | Psychiatry & Neurology | 10830 Highway 62, Eagle Point, OR 97524-9516 | 2015-07-01 |
| 1023440435 | Providence Health & Services - Oregon | General Acute Care Hospital | 11445 Se Moon Dust Ct, Happy Valley, OR 97086-8033 | 2013-08-08 |
| 1568793313 | Providence Health & Services - Oregon | Clinic/Center | 17550 Provost St Ste 201, Lake Oswego, OR 97034-5199 | 2010-01-19 |
| 1508015348 | Providence Health & Services - Oregon | Clinic/Center | 16180 Se Sunnyside Road, Suite 102, Happy Valley, OR 97015-6302 | 2008-09-17 |
| 1114085545 | Providence Health & Services - Oregon | Internal Medicine | 1314 E Sherman St, Newberg, OR 97132-1842 | 2006-12-05 |
| 1629146121 | Providence Health & Services - Oregon | Otolaryngology | 310 Villa Rd, Suite 104, Newberg, OR 97132-1886 | 2006-12-01 |
| 1992882500 | Providence Health & Services - Oregon | Clinic/Center | 205 N Phoenix Rd, Suite A, Phoenix, OR 97535-9104 | 2006-11-01 |
| 1013018175 | Providence Health & Services - Oregon | Clinic/Center | 510 Bridge St, Vernonia, OR 97064-1218 | 2006-09-25 |
| 1447799523 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd Ste 170, Medford, OR 97504-5590 | 2017-02-22 |
| 1063963106 | Providence Health & Services - Oregon | Clinic/Center | 1698 E Mcandrews Rd, Ste 300, Medford, OR 97504-5589 | 2016-10-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Providence Health & Services - Oregon | 1801 Lind Avenue, Sw, Renton, WA 98057-9016 |
| Oregon Corporations, Companies and Business Names | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw #9016, Renton, WA 98057 |
| System for Award Management (SAM) Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 4400 Ne Halsey St Bldg 2 Ste 690, Portland, OR 97213-1545 |
| Iowa Business Entities | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave. Sw, Renton, WA 98057 |
| Washington State Corporations | PROVIDENCE HEALTH & SERVICES - OREGON | 1801 Lind Ave Sw # 9016, Renton, WA 98057 |
| Street Address |
4805 NE GLISAN ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97213-2933 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255337572 | John F Zurasky | Psychiatry & Neurology | 4805 Ne Glisan St, Ste 3g37, Portland, OR 97213-2933 | 2005-06-22 |
| 1083228175 | Alysia M Paaluhi | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-09-04 |
| 1619595964 | Kathleen Hahn | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-07-13 |
| 1841839107 | Daniel Dean Rosema | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2020-01-03 |
| 1588207666 | Jean Hannon Mullins-padgett | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-22 |
| 1043853146 | Miranda Meyer | Dietitian, Registered | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-10-21 |
| 1083260830 | Becky L Bowler | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-08-16 |
| 1366096406 | Nicole W Engel | Registered Nurse | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-07-26 |
| 1558924753 | Susan Lien | Nurse Practitioner | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-04-15 |
| 1356809644 | Katheryne Zempel | Physical Therapist | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2019-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831715176 | Darnell Jackie Strong | Social Worker | 435 Ne 78th Ave 'strong Counseling Services', Portland, OR 97213 | 2020-06-23 |
| 1336775907 | Redpoint Physical Therapy and Performance LLC | Physical Therapist | 4200 Ne Flanders St Unit B, Portland, OR 97213 | 2020-03-16 |
| 1801431218 | Denise Dorgan-miller | Occupational Therapy Assistant | Providence Elder Place, 4400 Ne Halsey Suite 200, Portland, OR 97213 | 2019-11-08 |
| 1619435617 | Aspiration of Character Counseling Services, LLC | Counselor | 4424 Ne Glisan St, The Li Wellness Building, Second Floor, Portland, OR 97213 | 2019-03-08 |
| 1578049631 | Credena Health LLC | Pharmacy | 4805 Ne Glisan St Ste 11n321, Portland, OR 97213 | 2018-07-12 |
| 1023507795 | Karissa Lynn Schwartz | Speech-Language Pathologist | Providence Portland Medical Center, 4805 Ne Glisan St, Portland, OR 97213 | 2018-05-08 |
| 1861944506 | James Livingston Taylor | Chiropractor | 5212 Ne Sacremento St., Portland, OR 97213 | 2016-10-28 |
| 1962958520 | Caitlin Turner | Massage Therapist | 4317 Ne Tillamook St., Portland, OR 97213 | 2016-09-01 |
| 1326407008 | Julianna Vermeys | Counselor | 4605 Ne Fremont St., 209a, Portland, OR 97213 | 2016-02-23 |
| 1881059822 | Thomas Michael Barrett | Counselor | 5228 Ne Hoyt St. Bldg. B, Portland, OR 97213 | 2015-12-17 |
| Find all providers in zip 97213 | ||||
| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821517533 | Indiana University Health Jay, Inc. | Psychiatric Unit | 500 W Votaw St, Portland, IN 47371-1322 | 2017-09-13 |
| 1245773225 | Legacy Emanuel Hospital & Health Center | Psychiatric Unit | 1225 Ne 2nd Ave, Portland, OR 97232-2003 | 2016-11-23 |
| 1164811972 | Providence Health & Services Oregon | Psychiatric Unit | 9205 Sw Barnes Rd, Portland, OR 97225-6603 | 2015-01-16 |
| 1023194271 | Providence Health & Services - Oregon | Psychiatric Unit | 4805 Ne Glisan St, Portland, OR 97213-2933 | 2006-10-31 |
| 1164507695 | Portland Veterans Affairs Medical Center | Psychiatric Unit | 3710 Sw Us Veterans Hospital Rd, Portland, OR 97239-2964 | 2006-10-25 |
| 1003822487 | Legacy Emanuel Hospital & Health Center | Psychiatric Unit | 1225 Ne 2nd Ave, Portland, OR 97232-2003 | 2006-07-31 |
| 1336162874 | Legacy Good Samaritan Hospital and Medical Center | Psychiatric Unit | 1015 Nw 22nd Ave, Portland, OR 97210-3025 | 2006-07-25 |
| 1811917222 | Mainehealth | Psychiatric Unit | 22 Bramhall St, Portland, ME 04102 | 2006-07-20 |
| 1275506024 | Jay County Hospital | Psychiatric Unit | 500 W Votaw St, Portland, IN 47371-1322 | 2006-02-10 |
| 1033191309 | Portland Adventist Medical Center | Psychiatric Unit | 10123 Se Market St, Portland, OR 97216-2532 | 2005-11-14 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.