| NPI | 1609587708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN GLOCK Partner 503-888-8050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-09 |