| NPI | 1578847737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE IVAR. HANNIBAL Owner/Operator 503-254-1545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR L525) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |