Healthcare Provider Details

I. General information

NPI: 1235091737
Provider Name (Legal Business Name): MINDSTEAD RTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 SE SALQUIST RD
GRESHAM OR
97080-6106
US

IV. Provider business mailing address

5825 SE SALQUIST RD
GRESHAM OR
97080-6106
US

V. Phone/Fax

Practice location:
  • Phone: 503-809-1561
  • Fax:
Mailing address:
  • Phone: 503-809-1561
  • 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: LEUL ALEMU
Title or Position: ADMINSTRATOR
Credential:
Phone: 503-809-1561