Basic Information
| Provider Information | |||||||||
| NPI: | 1881637809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTIECARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | CHRISTIE SCHOOL | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 368 | ||||||||
| Address2: | |||||||||
| City: | MARYLHURST | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970360368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036353416 | ||||||||
| FaxNumber: | 5036976932 | ||||||||
| Practice Location | |||||||||
| Address1: | 2507 CHRISTIE DR | ||||||||
| Address2: | |||||||||
| City: | MARYLHURST | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036353416 | ||||||||
| FaxNumber: | 5036976932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | THERESA | ||||||||
| AuthorizedOfficialFirstName: | DEIBELE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE AND ADMINISTRATION DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5036752228 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 385HR2055X | OR | N | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | 322D00000X | OR | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 323P00000X | OR | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.