Healthcare Provider Details

I. General information

NPI: 1467356659
Provider Name (Legal Business Name): FORWARD PATH LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 SE 103RD AVE
PORTLAND OR
97266-6054
US

IV. Provider business mailing address

7321 SE 103RD AVE
PORTLAND OR
97266-6054
US

V. Phone/Fax

Practice location:
  • Phone: 503-703-7167
  • Fax:
Mailing address:
  • Phone: 503-703-7167
  • 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: ZEKARYAS ADEM
Title or Position: DIRECTOR
Credential:
Phone: 503-703-7167