MEDICARE: HARBORSTONE BEHAVIORAL RESIDENCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1952260572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBORSTONE BEHAVIORAL RESIDENCE LLC

Provider Business Mailing Address
First Line	:	1426 NE HIGHLAND ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-4134
Country	:	US
Telephone Number	:	720-587-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 NE HIGHLAND ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-4134
Country	:	US
Telephone Number	:	720-587-5665
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AKLILU ZERIHUM
Credential	:	ZERIHUM
Telephone Number	:	720-587-5665

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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