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NPI 1720118813 · Mental Illness Community Based Residential Treatment Facility · Portland, OR
Provider details
- NPI number
- 1720118813
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- Jessie Isaac, Residential Councelor
Mailing address
3608 Se 40th Ave Apt 3
Portland, OR 97202-1769
Registry dates
- Enumerated
- 2007-03-07
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.