Healthcare Provider Details

I. General information

NPI: 1811852346
Provider Name (Legal Business Name): CHERINET SUMAMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 SE SPRUCE ST
HILLSBORO OR
97123-4729
US

IV. Provider business mailing address

7204 NE RIDGE DR
HILLSBORO OR
97124-5162
US

V. Phone/Fax

Practice location:
  • Phone: 503-984-5643
  • Fax: 971-501-1060
Mailing address:
  • Phone: 503-984-5643
  • Fax: 971-501-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: