Healthcare Provider Details

I. General information

NPI: 1578479382
Provider Name (Legal Business Name): AETERNA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 SE BRIAN ST
HILLSBORO OR
97123-7011
US

IV. Provider business mailing address

3069 SE BRIAN ST
HILLSBORO OR
97123-7011
US

V. Phone/Fax

Practice location:
  • Phone: 781-309-8976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: WILSON KISAMBIRA
Title or Position: DIRECTOR
Credential:
Phone: 781-309-8976