| NPI | 1922209121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZY VENZKE Sr. Billing Manager 503-205-4362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2025-07-22 |