Healthcare Provider Details

I. General information

NPI: 1568326429
Provider Name (Legal Business Name): IMPERIAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20105 SW IMPERIAL ST
ALOHA OR
97003-2110
US

IV. Provider business mailing address

20105 SW IMPERIAL ST
ALOHA OR
97003-2110
US

V. Phone/Fax

Practice location:
  • Phone: 781-309-8976
  • Fax:
Mailing address:
  • Phone: 781-309-8976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ELIZABEH NJERU GIBBONS
Title or Position: DIRECTOR
Credential:
Phone: 978-407-1386