IMPACT NW (NPI# 1417495862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417495862 |
| Entity Type | Organization |
| Organization Name | IMPACT NW |
| Practice Address |
7211 Se 62nd Ave Portland OR 97206-7564 |
| Mailing Address |
Po Box 33530 Portland OR 97292-3530 |
| Practice Telephone | 5034897034 |
| Mailing Telephone | 5032947400 |
| Mailing Fax Number | 5038020046 |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | AMANDA ADAMS (LTK PROJECT COORDINATOR) |
| Authorized Official Telephone | 5412278888 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 251B00000X | Case Management | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500721499 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 355 Nw Division St, Gresham, OR 970305523 | 5036743610 | 5036743620 |
| 10305 E Burnside St, Portland, OR 972162733 | 5039886400 | 5039886473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053624387 | Impact Nw | Community/Behavioral Health | 7211 Se 62nd Ave, Portland, OR 97206 | 2010-07-15 |
| Street Address |
7211 SE 62ND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97206-7564 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205012838 | Reginald Timothy Snow | Counselor | 7211 Se 62nd Ave, Portland, OR 97206-7564 | 2008-01-14 |
| 1972021327 | Esperanza Valencia | Counselor | 7211 Se 62nd Ave, Portland, OR 97206-7564 | 2017-09-06 |
| 1740632090 | Erin Fanshier | Social Worker | 7211 Se 62nd Ave, Portland, OR 97206-7564 | 2016-07-11 |
| 1548612179 | Katherine Lefco | Social Worker | 7211 Se 62nd Ave, Portland, OR 97206-7564 | 2016-07-07 |
| 1053624387 | Impact Nw | Community/Behavioral Health | 7211 Se 62nd Ave, Portland, OR 97206 | 2010-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346852365 | Amanda Kristine Fredrickson | Dietitian, Registered | 3611 Se 64th Ave., Portland, OR 97206 | 2020-08-20 |
| 1578108940 | Amy Groulx | Technician | 5506 Se Mitchell St, Portland, OR 97206 | 2019-11-08 |
| 1477061265 | Lisa Marie Matejka | Naturopath | 5235 Se Lambert St, Apt. #b6, Portland, OR 97206 | 2018-01-16 |
| 1639625205 | Mollie Kathleen Pence | Registered Nurse | 2415 43rd Ave, Suite 100, Cascadia Behavioral Healthcare Urgent Walkin Clinic, Portland, OR 97206 | 2016-09-01 |
| 1457709164 | Lauren Murdoch | Massage Therapist | 4629 Southeast Woodstock Boulevard, Portland, OR 97206 | 2016-06-03 |
| 1962897785 | Meigra Simon LLC | Mechanotherapist | 6842 Se Henry St, Portland, OR 97206 | 2015-03-30 |
| 1891186508 | Teresa Leckron-myers | Case Manager/Care Coordinator | 7916 Se Foster Rd, Portland, OR 97206 | 2015-02-17 |
| 1831597590 | Boey Yean Lim | Acupuncturist | 4629 Se Woodstock Blvd, Portland, OR 97206 | 2014-12-12 |
| 1295082329 | Chase Heywood Price | Acupuncturist | 5425 Se Raymond Street, Portland, OR 97206 | 2012-08-08 |
| 1154678423 | Annelise Sevastiana Schnase | Counselor | 4311 Se Woodstock Blvd, Portland, OR 97206 | 2012-08-06 |
| Find all providers in zip 97206 | ||||
| Taxonomy Code | 251B00000X |
| Grouping | Agencies |
| Classification | Case Management |
| An organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821524943 | Engility Enterprises LLC | Case Management | 1 Coast Lane, Portland, ME 04103 | 2017-05-10 |
| 1568901908 | Usa Family Well Being Services LLC | Case Management | 500 Forest Ave Ste 6, Portland, ME 04101-1520 | 2017-02-17 |
| 1568900108 | New England Integrated Living Support | Case Management | 228 Sherwood St, 2, Portland, ME 04103-5026 | 2017-02-02 |
| 1154878627 | Oregon Outreach Inc | Case Management | 1740 South East 139th Avenue, Portland, OR 97233 | 2016-09-01 |
| 1407206287 | Preble Street | Case Management | 38 Preble St, Portland, ME 04101-4952 | 2016-06-13 |
| 1144684663 | Catholic Charities | Case Management | 2740 Se Powell Blvd., Portland, OR 97202 | 2016-04-11 |
| 1619333846 | Maine Pretrial Services, Inc. | Case Management | 175 Lancaster St Ste 305, Portland, ME 04101-2451 | 2016-01-04 |
| 1558744862 | Innerlight Healing Arts | Case Management | 3128 Se 45th Ave, Portland, OR 97206-2205 | 2015-07-06 |
| 1396128765 | Maine State Interpreters | Case Management | 237 Oxford St Ste 26c, Portland, ME 04101-3190 | 2015-07-03 |
| 1205228590 | Pine Tree Commuinty Services, LLC | Case Management | 171 Warren Ave, Portland, ME 04103-1103 | 2015-02-24 |
| 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.