Kaiser Permanente

NPI #1265676605 in Clackamas, Oregon

Provider Information

NPI Number: 1265676605
Entity Type: Organization
Organization Name: Kaiser Permanente
Primary Specialty: Special Hospital
Enumeration Date: Apr 29, 2009
Last Updated: Apr 29, 2009

Practice Location

Address: 10180 SE SUNNYSIDE AVE 1ST FLOOR, WING A
Address 2: BROOKSIDE CENTER RESIDENTIAL TREATMENT
City: Clackamas
State: Oregon
ZIP Code: 97015-9303
Phone: (503) 571-0858

Authorized Official

Name: JOHNNY DEAN GONZALES, BS
Title: MILIEU COUNSELOR
Phone: (503) 571-0858

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Special Hospital	284300000X	Primary

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