Healthcare Provider Details

I. General information

NPI: 1457271553
Provider Name (Legal Business Name): MARK COMFORT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 WILLOW LEAF ST N
KEIZER OR
97303-7518
US

IV. Provider business mailing address

5295 WILLOW LEAF ST N
KEIZER OR
97303-7518
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-2110
  • Fax: 971-343-2977
Mailing address:
  • Phone: 503-390-2110
  • Fax: 971-343-2977

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: JEAN PIERRE RUGWIZANGOGA
Title or Position: OWNER
Credential:
Phone: 502-936-9618