| NPI | 1083154637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYANN MISHELL MOORE Manager/Owner 503-706-8413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 5355) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |