Healthcare Provider Details

I. General information

NPI: 1003720756
Provider Name (Legal Business Name): NEW PATH RESIDENTIAL. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16005 SE TAGGART ST
PORTLAND OR
97236-1948
US

IV. Provider business mailing address

16005 SE TAGGART ST
PORTLAND OR
97236-1948
US

V. Phone/Fax

Practice location:
  • Phone: 310-686-5423
  • Fax:
Mailing address:
  • Phone: 310-686-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: LIA N YEMANE-BERHAN
Title or Position: OWNER
Credential:
Phone: 310-686-5423