| NPI | 1235749987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH K CROWNER Executive Director 971-216-9732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-08-07 |