Healthcare Provider Details

I. General information

NPI: 1114851078
Provider Name (Legal Business Name): EMO RESIDENTIAL CARE HOME,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 NE ROBERTS AVE
GRESHAM OR
97030-2769
US

IV. Provider business mailing address

2780 NE ROBERTS AVE
GRESHAM OR
97030-2769
US

V. Phone/Fax

Practice location:
  • Phone: 503-847-5970
  • Fax:
Mailing address:
  • Phone: 503-847-5970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GURMU MEBRAT YADETO
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-847-5970