Healthcare Provider Details

I. General information

NPI: 1609794486
Provider Name (Legal Business Name): SHILOAH SPRINGS TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2148 CERISE AVE NW
SALEM OR
97304-2147
US

IV. Provider business mailing address

2148 CERISE AVE NW
SALEM OR
97304-2147
US

V. Phone/Fax

Practice location:
  • Phone: 503-383-4418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ISAIAH MAINA
Title or Position: DIRECTOR
Credential:
Phone: 503-383-4418