Healthcare Provider Details

I. General information

NPI: 1427981679
Provider Name (Legal Business Name): NIHA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4492 HUDSON AVE NE
SALEM OR
97301-5153
US

IV. Provider business mailing address

4819 MEHAMA LOOP NE
SALEM OR
97305-3084
US

V. Phone/Fax

Practice location:
  • Phone: 503-328-5037
  • Fax:
Mailing address:
  • Phone: 503-328-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NITA T GODEBO
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-328-5037