IndividualActive
Lidya Yifru
NPI 1033934476 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Beaverton, OR
Provider details
- NPI number
- 1033934476
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
- Community Health Worker172V00000X
Other Service Providers
Practice location
4780 Sw 166th Ave
Beaverton, OR 97078-1955
Phone: (206) 698-0382
Approximate (ZIP-level) locationGet directions
Mailing address
4780 Sw 166th Ave
Beaverton, OR 97078-1955
Registry dates
- Enumerated
- 2024-11-20
- Last updated
- 2024-11-20
- Certified
- 2024-11-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.