| NPI | 1013481993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALIM OTIENO ODIERO Administrator 503-805-9203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2020-06-10 |