| Ayco | |
|
1390 Se 122nd Ave Ste Ue Portland OR 97233-1203 | |
| (971) 254-8916 | |
| Not Available |
| Full Name | Ayco |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 1390 Se 122nd Ave Ste Ue, Portland, Oregon |
| Authorized Official Name and Position | Jamal Dar (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5034758802 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ayco 432 Ne 74th Ave Portland OR 97213-6312 Ph: (971) 254-8916 | Ayco 1390 Se 122nd Ave Ste Ue Portland OR 97233-1203 Ph: (971) 254-8916 |
| NPI Number | 1326649500 |
|---|---|
| Provider Enumeration Date | 11/04/2020 |
| Last Update Date | 06/22/2021 |
| Certification Date | 06/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326649500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | () | Primary |
| 172V00000X | Community Health Worker | () | Secondary |
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