Healthcare Provider Details

I. General information

NPI: 1861356214
Provider Name (Legal Business Name): WILLOW PATH RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18570 SW HONEYWOOD DR
BEAVERTON OR
97003-2915
US

IV. Provider business mailing address

18570 SW HONEYWOOD DR
BEAVERTON OR
97003-2915
US

V. Phone/Fax

Practice location:
  • Phone: 480-743-7912
  • Fax:
Mailing address:
  • Phone: 480-743-7912
  • 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: MR. YVES MUGABA
Title or Position: ADMINISTRATOR
Credential:
Phone: 480-743-7912