Healthcare Provider Details

I. General information

NPI: 1629989462
Provider Name (Legal Business Name): LENSA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 NE SHAVER ST
PORTLAND OR
97230-1453
US

IV. Provider business mailing address

13250 NE SHAVER ST
PORTLAND OR
97230-1453
US

V. Phone/Fax

Practice location:
  • Phone: 971-230-8488
  • Fax: 971-888-5174
Mailing address:
  • Phone:
  • 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 State

VIII. Authorized Official

Name: BERHANU KEBEDE BEDASSA
Title or Position: ADMINISTRATOR
Credential: PMHNP
Phone: 213-249-6973