Active Independence Oregon

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

ACTIVE INDEPENDENCE OREGON

Practice address

3929 NE 78TH Ave Apt 12
Portland, OR 97213-6400

Phone

(507) 219-0122

NPI assigned

Nov 25, 2024

Last updated

Nov 25, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Riley Deboest

Title

Director/Owner

Phone

(507) 219-0122

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1902622921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 NE 78TH AVE APT 12",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972136400",
            "telephone_number": "507-219-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 NE 78TH AVE APT 12",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972136400",
            "telephone_number": "507-219-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE INDEPENDENCE OREGON",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-24",
        "status": "A",
        "authorized_official_last_name": "DEBOEST",
        "authorized_official_first_name": "RILEY",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "507-219-0122"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.