Healthcare Provider Details

I. General information

NPI: 1033087630
Provider Name (Legal Business Name): SABR RTH FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 SW EASTWOOD AVE
GRESHAM OR
97080-9784
US

IV. Provider business mailing address

2602 SW PHYLLIS DR
GRESHAM OR
97080-6319
US

V. Phone/Fax

Practice location:
  • Phone: 206-519-1092
  • Fax:
Mailing address:
  • Phone: 206-519-1092
  • 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: SEMIRA OSMAN
Title or Position: PROGRAM ADMINISTRATOR
Credential: BACHELOR
Phone: 206-519-1092