Provider Demographics
NPI:1043097538
Name:BH-OR OP MLK, LLC
Entity type:Organization
Organization Name:BH-OR OP MLK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:858-254-2510
Mailing Address - Street 1:PO BOX 12269
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-0269
Mailing Address - Country:US
Mailing Address - Phone:858-254-2510
Mailing Address - Fax:
Practice Address - Street 1:4943 NE MARTIN LUTHER KING BLVD # 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3353
Practice Address - Country:US
Practice Address - Phone:503-504-4042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health