Healthcare Provider Details

I. General information

NPI: 1881513638
Provider Name (Legal Business Name): NORTHWEST SERENITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 SE BAKER AVE
GRESHAM OR
97080-2018
US

IV. Provider business mailing address

373 SE BAKER AVE
GRESHAM OR
97080-2018
US

V. Phone/Fax

Practice location:
  • Phone: 717-877-7309
  • Fax: 717-877-7309
Mailing address:
  • Phone: 717-877-7309
  • Fax: 717-877-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: GRACE NYIHA WANYOIKE
Title or Position: MANAGING DIRECTOR
Credential: RN
Phone: 717-877-7309