| NPI | 1265570287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGGIE ALISON COBBEY Residential Counselor 503-238-0769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-08-22 |