Healthcare Provider Details

I. General information

NPI: 1811814387
Provider Name (Legal Business Name): AVIA TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SE 282ND AVE
GRESHAM OR
97080-8999
US

IV. Provider business mailing address

8830 NE SACRAMENTO ST
PORTLAND OR
97220-5453
US

V. Phone/Fax

Practice location:
  • Phone: 508-439-9080
  • Fax:
Mailing address:
  • Phone: 508-439-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DINAH NOYST
Title or Position: OWNER
Credential: RN
Phone: 508-439-9080