| NPI | 1578038212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRELL GRAY Owner 503-744-9180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2018-10-09 |