Northstar Iop LLC
Clinic/Center, Rehabilitation, Substance Use Disorder in Beaverton, OR. Organization (NPI-2).
NPI number1609587708
StatusActive
Last updated in NPPESDec 9, 2022
Details
- NPI
- 1609587708
- Entity type
- Organization (NPI-2)
- Legal business name
- Northstar Iop LLC
- Organization subpart
- No
- Enumeration date
- Dec 9, 2022
- Certification date
- Dec 8, 2022
- Last updated
- Dec 9, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | Yes |
Practice location
16100 Nw Cornell Rd Ste 220bBeaverton, OR 97006-7334
Phone 503-878-8885
Mailing address
16100 Nw Cornell Rd Ste 220bBeaverton, OR 97006-7334
Authorized official
Ryan Glock
Partner
5038888050
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