PARKSIDE LIVING RTF NPI 1447405147

NPI Information

NPI: 1447405147
Provider Name: PARKSIDE LIVING RTF
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization

CLIA Number: 38D2269025

Address:
1525 SW SHIRLEY ANN DR
MCMINNVILLE, OR
ZIP 97128
Phone: (503) 472-9603
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PARKSIDE LIVING RTF is a community based residential treatment facility mental illness in Mcminnville, OR. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. PARKSIDE LIVING RTF NPI is 1447405147. The provider is registered as an organization entity type.

The provider's business location address is:

1525 SW SHIRLEY ANN DR
MCMINNVILLE, OR
ZIP 97128-665
Phone: (503) 472-9603

The provider's authorized official is Pooneh Entezari .
The authorized official title is Owner and has the following contact phone number (503) 309-6202.

The CLIA number assigned to this NPI record is 38D2269025 - other - residential care facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/21/2008 and was last updated on 11/21/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness			OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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