Healthcare Provider Details

I. General information

NPI: 1093661456
Provider Name (Legal Business Name): SOLANA RESIDENTIAL TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 SE 5TH ST
GRESHAM OR
97080-8169
US

IV. Provider business mailing address

1530 SE 5TH ST
GRESHAM OR
97080-8169
US

V. Phone/Fax

Practice location:
  • Phone: 408-594-4644
  • Fax:
Mailing address:
  • Phone: 408-594-4644
  • 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: MS. YANET TESHAGER
Title or Position: ADMINISTRATOR
Credential: RN, BSN, PHN
Phone: 408-594-4644