Healthcare Provider Details

I. General information

NPI: 1497672083
Provider Name (Legal Business Name): WINDROSE GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 SW 218TH DR
BEAVERTON OR
97003-1359
US

IV. Provider business mailing address

2297 SW 218TH DR
BEAVERTON OR
97003-1359
US

V. Phone/Fax

Practice location:
  • Phone: 503-997-1691
  • Fax:
Mailing address:
  • Phone: 503-997-1691
  • 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: ZAKARIYA ALI
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 503-997-1691