Healthcare Provider Details

I. General information

NPI: 1265356232
Provider Name (Legal Business Name): REHOBOTH TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21675 SW JAY ST
BEAVERTON OR
97003-7072
US

IV. Provider business mailing address

21675 SW JAY ST
BEAVERTON OR
97003-7072
US

V. Phone/Fax

Practice location:
  • Phone: 510-227-4685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TSEHAY ZELEKE BEFIRDU
Title or Position: OWNER
Credential: DIRECTOR
Phone: 510-227-4685