| NPI | 1154686632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHEA BRAXTON Nursing Supervisor 503-234-9591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: OR 200840633RN) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |