| NPI | 1043950868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA SHORT Administrator 971-312-2091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-03-30 |