Healthcare Provider Details

I. General information

NPI: 1083326367
Provider Name (Legal Business Name): BRIDGE OF HOPE MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6517 NE SANDY BLVD
PORTLAND OR
97213-4569
US

IV. Provider business mailing address

6517 NE SANDY BLVD
PORTLAND OR
97213-4569
US

V. Phone/Fax

Practice location:
  • Phone: 213-249-6973
  • Fax: 503-386-3303
Mailing address:
  • Phone: 213-249-6973
  • Fax: 503-386-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BERHANU KEBEDE BEDASSA
Title or Position: OWNER
Credential: PMHNP
Phone: 213-249-6973