| NPI | 1033340096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ESTERA BODALE Care Provider 503-760-4262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OR 0312-513850-0803-P) |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OR 03125138500803P) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |