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64th Ave Llc
Mental Illness Community Based Residential Treatment Facility in Milwaukie, Oregon
NPI 1912152570

64th Ave Llc is a Mental Illness Community Based Residential Treatment Facility based in Milwaukie, OR. 64th Ave Llc practices in Milwaukie, OR. The NPI Number for 64th Ave Llc is 1912152570 and holds a License No. 869 (Oregon).

The current practice location address for 64th Ave Llc is 4199 Se King Rd, Milwaukie, OR and can be reached out via phone at 503-786-3830 and via fax at 503-653-3534.

Location: 4199 Se King Rd, Milwaukie, OR, 97222-5892
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1912152570
Provider Name
64th Ave Llc
Credential
Provider Entity Type
Organization
Address
4199 Se King Rd, Milwaukie, OR, 97222-5892
Phone Number
503-786-3830
Fax Number
503-653-3534
Provider Enumeration Date
11/24/2008
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
4199 Se King Rd
City
Milwaukie
State
Oregon
Zip
97222-5892
Phone Number
503-786-3830
Fax Number
503-653-3534
person
Provider Business Mailing Address Details
Address
4199 Se King Rd
City
Milwaukie
State
Oregon
Zip
97222-5892
Phone Number
503-786-3830
Fax Number
503-653-3534
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Mental Illness
Speciality
-
Taxonomy
320800000X
License No.
869 (Oregon)
Definition
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
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