CENTRAL CITY CONCERN, INC (NPI# 1932674801) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932674801 |
| Entity Type | Organization |
| Organization Name | CENTRAL CITY CONCERN, INC |
| Other Organization Name | BLACKBURN CENTER |
| Practice Address |
12121 E Burnside St Portland OR 97216-3737 |
| Mailing Address |
232 Nw 6th Avenue Attn: Credentialing Portland OR 97209 |
| Practice Telephone | 9713617700 |
| Mailing Telephone | 5035015641 |
| Mailing Fax Number | 5032944321 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2019-04-22 |
| Authorized Official Name | DR. RACHEL SOLOTAROFF (PRESIDENT & CEO) |
| Authorized Official Telephone | 5032941681 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Blackburn Center | Other Name - Individual/Organization |
| Street Address |
12121 E BURNSIDE ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-3737 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528371358 | Elisia Lopez-mendiola | Counselor | 12121 E Burnside St, Portland, OR 97216-3737 | 2010-07-21 |
| 1245846955 | Danie Marie Primmer | Counselor | 12121 E Burnside St, Portland, OR 97216-3737 | 2020-09-17 |
| 1003425489 | A'lissa Richards | Nurse Practitioner | 12121 E Burnside St, Portland, OR 97216-3737 | 2020-07-30 |
| 1013526714 | Christopher Anthony Welsch | Counselor | 12121 E Burnside St, Portland, OR 97216-3737 | 2020-07-28 |
| 1013525211 | Heather Curran Fare | Social Worker | 12121 E Burnside St, Portland, OR 97216-3737 | 2020-07-14 |
| 1609426816 | Misti Ranee Miller | Counselor | 12121 E Burnside St, Portland, OR 97216-3737 | 2019-09-19 |
| 1619523255 | Annastacia Desiree Weiss | Counselor | 12121 E Burnside St, Portland, OR 97216-3737 | 2019-08-09 |
| 1023676640 | Elona Kassia Dellabough-gormley | Registered Nurse | 12121 E Burnside St, Portland, OR 97216-3737 | 2019-05-29 |
| 1730747353 | Holly Natasha Herrera | Registered Nurse | 12121 E Burnside St, Portland, OR 97216-3737 | 2019-05-29 |
| 1437624046 | Central City Concern | Pharmacy | 12121 E Burnside St, Portland, OR 97216-3737 | 2018-10-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679047872 | Portland Community Health Center | Clinic/Center | 52 Frederic St, Portland, ME 04102-2700 | 2019-01-22 |
| 1043783822 | Portland Community Health Center | Clinic/Center | 72 Bishop St, Portland, ME 04102-2957 | 2019-01-04 |
| 1770056558 | Portland Community Health Center | Clinic/Center | 190 Valley Street, Portland, ME 04102-2957 | 2019-01-04 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1700317971 | Portland Community Health Center | Clinic/Center | 28 Portland St, Portland, ME 04101-2912 | 2017-03-21 |
| 1255872537 | Portland Community Health Center | Clinic/Center | 175 Auburn St, Portland, ME 04103-2131 | 2017-03-20 |
| 1477005619 | Outside In | Clinic/Center | 1226 Sw 12th Ave, Portland, OR 97205-2029 | 2016-11-03 |
| 1649636986 | Mainline Health Systems, Inc | Clinic/Center | 314 Highway 160 E, Portland, AR 71663-9262 | 2015-12-31 |
| 1144691098 | Central City Concern Inc | Clinic/Center | 2566 Ne Hoyt St, Portland, OR 97232-2323 | 2015-10-16 |
| 1295119386 | Central City Concern Inc | Clinic/Center | 12133 E. Burnside St, Portland, OR 97216-2344 | 2015-07-17 |
| 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.