Basic Information
| Provider Information | |||||||||
| NPI: | 1881830412 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOURNEY OF HOPE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | GLADSTONE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970270249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036504359 | ||||||||
| FaxNumber: | 5036506913 | ||||||||
| Practice Location | |||||||||
| Address1: | 8305 SE MONTEREY AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036504359 | ||||||||
| FaxNumber: | 5036506913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2009 | ||||||||
| LastUpdateDate: | 01/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | ORREN | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5036504359 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LSCW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L3566 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.