NPIMap

Organization Active NPI

Polk Adolescent Day Treatment Center Inc

  • Community/Behavioral Health Agency
  • Dallas, OR
National Provider Identifier
1922175496
Registry record updated Mar 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
POLK ADOLESCENT DAY TREATMENT CENTER INC
Practice address
2200 E Ellendale
Dallas, OR 97338
Phone
(503) 623-5588
Fax
(503) 623-5588
NPI assigned
Nov 29, 2006
Last updated
Mar 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2013

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

Authorized official

Name
Daniel Strasser, MC
Title
Executive Director
Phone
(503) 623-5588

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2200 E Ellendale
Dallas, OR 97338

Mailing address

2200 E Ellendale
Dallas, OR 97338
Phone (503) 623-5588

Other identifiers 1

IdentifierTypeStateIssuer
297982OtherORPROVIDER NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Eola Mental Health Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362614400000",
    "number": "1922175496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E ELLENDALE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "97338",
            "telephone_number": "503-623-5588",
            "fax_number": "503-623-4729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E ELLENDALE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "97338",
            "telephone_number": "503-623-5588",
            "fax_number": "503-623-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK ADOLESCENT DAY TREATMENT CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-03-07",
        "status": "A",
        "authorized_official_last_name": "STRASSER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-623-5588",
        "authorized_official_credential": "MC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "297982",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.