Basic Information
| Provider Information | |||||||||
| NPI: | 1104219211 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLIED HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 SE ALDER ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972142213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032262203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 SE ALDER ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972142213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032262203 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2015 | ||||||||
| LastUpdateDate: | 03/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | TIERNEY | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5032262203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CACD II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 140333 | OR | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.