ALBERTINA KERR CENTERS NPI 1003030305

Community Based Residential Treatment Facility, Mental Illness in Portland, OR

NPI 1003030305 Organization Community Based Residential Treatment Fa... CLIA Number 38D1043839 CLIA Certificate of Waiver

About ALBERTINA KERR CENTERS

Albertina Kerr Centers is a provider established in Portland, Oregon specializing in community based residential treatment facility, mental illness. The NPI number of Albertina Kerr Centers is 1003030305 and was assigned on April 2007. The practitioner's primary taxonomy code is 320800000X with license number 097006163RN (OR). The provider is registered as an organization and their NPI record was last updated 13 years ago. The authorized official of this NPI record is Kerri Frazier Rn (Director Of Nursing)

The CLIA number of Albertina Kerr Centers is 38D1043839 registered as a "other" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Albertina Kerr Centers to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003030305

Provider NameALBERTINA KERR CENTERS
Provider Location Address722 NE 162ND AVE PORTLAND, OR 97230
Provider Mailing Address722 NE 162 ND AVE PORTLAND, OR 97230
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date04-11-2007
Last Update Date06-12-2008


Primary Taxonomy

Taxonomy Code320800000X
ClassificationCommunity Based Residential Treatment Facility, Mental Illness
TypeResidential Treatment Facilities
License No.097006163RN
License StateOR
Taxonomy DescriptionA home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Business Address

ALBERTINA KERR CENTERS
722 NE 162ND AVE
PORTLAND, OR
ZIP 97230
Phone: (503) 408-5016
Fax: (503) 255-5094

Get Directions


Mailing Address

ALBERTINA KERR CENTERS
722 NE 162 ND AVE
PORTLAND, OR
ZIP 97230
Phone: (503) 408-5016
Fax: (503) 255-5094



Authorized Official

Authorized Official Name KERRI FRAZIER RN
Authorized Official TitleDIRECTOR OF NURSING
Authorized Official Phone(503) 408-5016

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003030305 is:

CLIA Number38D1043839
Facility TypeOTHER
Certificate TypeCertificate of Waiver

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
097006163RNOTHER (01)OR

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1235237983 CATHERINE N. KNOX QMHP
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1346334885 KATE ELIZABETH O'KELLEY M.A.
Individual
Counselor722 NE 162ND AVE
PORTLAND, OR 97230
(503) 445-0751
1811023310MISS GARNETT LYNN DITTFURTH M.A.
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 313-4497
1902936594DR. GRANT TYRONE GODBEY MD
Individual
Psychiatry & Neurology (Child & Adolescent Psychiatry)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1366561003 JENNIFER JO WOODS
Individual
Counselor722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1740309384 REGINA MARIA BRIMNER LCSW
Individual
Social Worker (Clinical)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1083734792MR. JOHN G CHILDERS MSW
Individual
Social Worker (Clinical)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-5083
1093836686MR. MARK A POLLOCK MS
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-4743
1033230073MRS. ANNA MICHELE DOOGAN MA
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-4740
1568584399MS. VIDA MAE JORDA RN
Individual
Registered Nurse (Psychiatric/Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1952424145MS. LAKINDRA MITCHELL MSW
Individual
Social Worker (Clinical)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 777-2929
1316161979 IAN T MOUSER
Individual
Social Worker722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1194940163MS. REBECCA CHARLENE KANTER M.A.
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1124243001 JESSICA FITZGERALD BA
Individual
Social Worker722 NE 162ND AVE
PORTLAND, OR 97230
(503) 329-7119
1457577058MRS. KERRI ELIZABETH FRAZIER RN
Individual
Registered Nurse (Psychiatric/Mental Health, Child & Adolescent)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1639396716 AMANDA HEARN MARCUS R.N.
Individual
Registered Nurse (Psychiatric/Mental Health, Child & Adolescent)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-5016
1528285640 JON SCHWARTZ M. ED.
Individual
Counselor (Mental Health)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 255-4205
1831316835 KEN J. BRINKER RN
Individual
Psychologist (Health Service)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-5016
1265650907MRS. LAURIE DIANE SWAN RN
Individual
Registered Nurse722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-5016
1851519375MR. ROBERT DEACON PROUTY RN
Individual
Registered Nurse (Psychiatric/Mental Health, Child & Adolescent)722 NE 162ND AVE
PORTLAND, OR 97230
(503) 408-5016

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.