Healthcare Provider Details

I. General information

NPI: 1851200554
Provider Name (Legal Business Name): OLIVE BRANCH RESIDENTIAL TREATMENT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 SE 151ST AVE
PORTLAND OR
97236-2325
US

IV. Provider business mailing address

2817 SE 151ST AVE
PORTLAND OR
97236-2325
US

V. Phone/Fax

Practice location:
  • Phone: 503-927-7775
  • Fax:
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: MISS NAOMI ALEMSEGED KASAHUN
Title or Position: OWNER
Credential:
Phone: 503-927-7775