| NPI | 1104236819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN C MIYASATO Owner 503-906-7870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 5855) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2014-06-06 |