Provider Demographics
NPI:1588333041
Name:COGNITIVE ENRICHMENT CONCEPTS LLC
Entity type:Organization
Organization Name:COGNITIVE ENRICHMENT CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-964-4335
Mailing Address - Street 1:1307 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1209
Mailing Address - Country:US
Mailing Address - Phone:503-964-4335
Mailing Address - Fax:503-512-7325
Practice Address - Street 1:1307 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1209
Practice Address - Country:US
Practice Address - Phone:503-964-4335
Practice Address - Fax:503-512-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness