Healthcare Provider Details

I. General information

NPI: 1619808870
Provider Name (Legal Business Name): DYNAMIC CORE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SW 198TH AVE
ALOHA OR
97078-2337
US

IV. Provider business mailing address

4560 SW 198TH AVE
ALOHA OR
97078-2337
US

V. Phone/Fax

Practice location:
  • Phone: 503-268-1326
  • Fax: 503-268-1341
Mailing address:
  • Phone: 503-268-1326
  • Fax: 503-268-1341

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: TERESIA W. MWANGI
Title or Position: LICENSEE
Credential:
Phone: 774-502-1828