NPIMap

Organization Active NPI

Providence Health & Services-Oregon

Doing business as Providence Child Center

  • Nursing Facility/Intermediate Care Facility
  • Portland, OR
National Provider Identifier
1376625137
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
1700250565 Issued in OR
Legal business name
PROVIDENCE HEALTH & SERVICES-OREGON
Doing business as
Providence Child Center
Practice address
830 NE 47TH Ave
Portland, OR 97213-2212
Phone
(503) 215-2400
Fax
(503) 215-0660
NPI assigned
Oct 20, 2006
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollments
Phone
(425) 358-9786

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 1700250565 OR Primary
Pediatric Skilled Nursing Facility 3140N1450X 1035453259 OR
Child Physical Disabilities Respite Care 385HR2065X 1035453259 OR

Addresses

Primary practice location

830 NE 47TH Ave
Portland, OR 97213-2212

Mailing address

830 NE 47TH Ave
Attn: Finance
Portland, OR 97213-2212
Phone (503) 215-2400

Other identifiers 3

IdentifierTypeStateIssuer
1035453259OtherORDEPT OF HUMAN SVCS
807297MedicaidOR
4570701MedicaidWA

Other names 1

  • Providence Child Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Providence Child Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1376625137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 NE 47TH AVE",
            "address_2": "ATTN: FINANCE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132212",
            "telephone_number": "503-215-2400",
            "fax_number": "503-215-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 NE 47TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972132212",
            "telephone_number": "503-215-2400",
            "fax_number": "503-215-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES-OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OR",
            "license": "1700250565",
            "primary": true
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "OR",
            "license": "1035453259",
            "primary": false
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": "OR",
            "license": "1035453259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF HUMAN SVCS",
            "identifier": "1035453259",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807297",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4570701",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Child Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Child Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.