| Life Renewal - Shedd Outpatient | |
|
18600 Se Mcloughlin Blvd Milwaukie OR 97267-6723 | |
| (971) 255-0658 | |
| Not Available |
| Full Name | Life Renewal - Shedd Outpatient |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 18600 Se Mcloughlin Blvd, Milwaukie, Oregon |
| Authorized Official Name and Position | Brian Nelson (COO) |
| Authorized Official Contact | 9712550658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Renewal - Shedd Outpatient 18600 Se Mcloughlin Blvd Milwaukie OR 97267-6723 Ph: (971) 255-0658 | Life Renewal - Shedd Outpatient 18600 Se Mcloughlin Blvd Milwaukie OR 97267-6723 Ph: (971) 255-0658 |
| NPI Number | 1245784222 |
|---|---|
| Provider Enumeration Date | 08/08/2016 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245784222 | NPI | - | NPPES |
| 500711843 | Medicaid | OR | |
| 90591 | Medicaid | MT | |
| 1712386 | Medicaid | AK | |
| 2173185 | Medicaid | WA |
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