Provider Type Icon

BRAVE SPACE LLC NPI 1255885919


NPI Information

NPI: 1255885919
Provider Name: BRAVE SPACE, LLC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
3620 SE POWELL BLVD # 102
PORTLAND, OR
ZIP 97202
Phone: (503) 486-8936
Get Directions

BRAVE SPACE, LLC is a community behavioral health in Portland, OR. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. BRAVE SPACE, LLC NPI is 1255885919. The provider is registered as an organization entity type.

The provider's business location address is:

3620 SE POWELL BLVD # 102
PORTLAND, OR
ZIP 97202-880
Phone: (503) 486-8936
Fax: (503) 894-6020

The provider's authorized official is Kate Kauffman .
The authorized official title is Owner, Supervisor and has the following contact phone number (503) 486-8936.

The enumeration date for this NPI number is 8/11/2016 and was last updated on 4/19/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthC3371OREGONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1500717457MEDICAIDOREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.