| NPI | 1427885722 |
|---|---|
| Doing Business As | JACKSON HOUSE PORTLAND SRTF 109TH |
| Entity Type | Organization |
| Authorized Contact | CHAD ENGBRECHT General Counsel 858-254-2510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2024-09-19 |