Healthcare Provider Details

I. General information

NPI: 1447069547
Provider Name (Legal Business Name): HARMONY RESIDENTIAL TREATMENT CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 NE COUNTRY CLUB AVE
GRESHAM OR
97030-4431
US

IV. Provider business mailing address

1620 NE COUNTRY CLUB AVE
GRESHAM OR
97030-4431
US

V. Phone/Fax

Practice location:
  • Phone: 458-262-4514
  • Fax:
Mailing address:
  • Phone: 458-262-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WILSON PAUL KISAMBIRA
Title or Position: MANAGER
Credential:
Phone: 781-309-8976