Provider Demographics
NPI:1053735563
Name:CANTERBURY CREST, INC.
Entity type:Organization
Organization Name:CANTERBURY CREST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-464-6740
Mailing Address - Street 1:PO BOX 19147
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0147
Mailing Address - Country:US
Mailing Address - Phone:503-464-6740
Mailing Address - Fax:
Practice Address - Street 1:8838 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3266
Practice Address - Country:US
Practice Address - Phone:503-464-6740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution