| NPI | 1013252618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY RAYE WEDDLE Registered Nurse 503-545-6284 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: OR 200840633RN) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |