Healthcare Provider Details

I. General information

NPI: 1699628800
Provider Name (Legal Business Name): GOLFWAY JOY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 NE COCHRAN DR
GRESHAM OR
97030-4411
US

IV. Provider business mailing address

1565 NE COCHRAN DR
GRESHAM OR
97030-4411
US

V. Phone/Fax

Practice location:
  • Phone: 971-379-5236
  • Fax:
Mailing address:
  • Phone: 971-379-5236
  • 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. CAROLINE PERRY
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 971-379-5236