| NPI | 1114546645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIGUEL TELLEZ Executive Director 503-888-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2020-04-14 |