| NPI | 1689011595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LACY Billing Manager 503-645-3581 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: OR 200027) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-12-05 |