Healthcare Provider Details

I. General information

NPI: 1265340350
Provider Name (Legal Business Name): ACCESS RESIDENTIAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 SE ELLIS ST
PORTLAND OR
97236-4211
US

IV. Provider business mailing address

12505 SE ELLIS ST
PORTLAND OR
97236-4211
US

V. Phone/Fax

Practice location:
  • Phone: 716-431-0767
  • Fax: 716-431-0767
Mailing address:
  • Phone: 716-431-0767
  • Fax: 716-431-0767

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: TSION HABTE
Title or Position: OWNER
Credential:
Phone: 716-431-0767