Provider Demographics
NPI:1689011595
Name:ZENITH HOUSE
Entity type:Organization
Organization Name:ZENITH HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-645-3581
Mailing Address - Street 1:5415 SW WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2409
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:503-629-8517
Practice Address - Street 1:8303 SW LOCUST ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8816
Practice Address - Country:US
Practice Address - Phone:503-645-3581
Practice Address - Fax:503-533-0152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEWORKS NORTHWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-31
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200027320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness