Healthcare Provider Details

I. General information

NPI: 1083539001
Provider Name (Legal Business Name): PRESTIGIOUS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 SE COOPER ST
DALLAS OR
97338-1946
US

IV. Provider business mailing address

556 SE COOPER ST
DALLAS OR
97338-1946
US

V. Phone/Fax

Practice location:
  • Phone: 503-751-1109
  • Fax:
Mailing address:
  • Phone: 503-751-1109
  • 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. BEKELE WAYU WARIYO
Title or Position: CEO/OWNER
Credential:
Phone: 240-204-7185