Healthcare Provider Details

I. General information

NPI: 1881511582
Provider Name (Legal Business Name): UNION RESIDENTIAL TREATMENT HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24141 SE OAK ST
GRESHAM OR
97030-8514
US

IV. Provider business mailing address

24141 SE OAK ST
GRESHAM OR
97030-8514
US

V. Phone/Fax

Practice location:
  • Phone: 404-552-9927
  • Fax:
Mailing address:
  • Phone:
  • 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: HIWOT ASSEFA AYALEW
Title or Position: MANAGER
Credential:
Phone: 404-552-9927