| NPI | 1104219211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TIERNEY Director 503-226-2203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OR 140333) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2024-05-14 |