Centennial School Base

LBN: Multnomah County
Centennial School Base is an health care organization with primary practice located at 3505 Se 182Nd Ave , Gresham OR 97030-5028. The organization recently has only one registered license in Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), which is considered as the primary health care specialty. Multnomah County can be contacted via phone (503) 988-5488, or through Moten, Derrick via phone (503) 988-2966.

Contact Information

Primary practice address
3505 Se 182Nd Ave Gresham OR 97030-5028
Phone: (503) 988-5488
Fax: (503) 988-5484
Website:
Map and Directions
Authorized official contact:
Name: Moten, Derrick
Phone: (503) 988-2966

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1912322074
LBN Legal business name Multnomah County
DBA Doing business as Centennial School Base
Authorized official Moten, Derrick
Entity Organization
Organization subpart 1 No
Enumeration date Feb 26th, 2014
Last updated May 18th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1912322074 NPPES
Oregon MEDICAID 096511
Oregon MEDICAID 22959

Popular Providers