Provider Demographics
NPI:1194282806
Name:OREGON ST. MARTIN CHARITIES ORG
Entity type:Organization
Organization Name:OREGON ST. MARTIN CHARITIES ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:176-092-7478
Mailing Address - Street 1:3601 SE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2433
Mailing Address - Country:US
Mailing Address - Phone:871-501-7727
Mailing Address - Fax:
Practice Address - Street 1:5239 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6822
Practice Address - Country:US
Practice Address - Phone:503-539-0136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care