| NPI | 1861233207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN LEMOTT JEMISON Owner/Provider 503-999-0404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2024-05-31 |
| Last Update Date | 2024-05-31 |