Healthcare Provider Details

I. General information

NPI: 1336026269
Provider Name (Legal Business Name): GOLDEN SPRINGS RESIDENCIAL TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 NW SLERET AVE
GRESHAM OR
97030-7030
US

IV. Provider business mailing address

80 NW SLERET AVE
GRESHAM OR
97030-7030
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-5993
  • Fax:
Mailing address:
  • Phone: 206-227-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL K KAMUGA
Title or Position: OWNER/PROVIDER
Credential:
Phone: 206-227-5993