Healthcare Provider Details

I. General information

NPI: 1215851415
Provider Name (Legal Business Name): GLOBAL RESIDENTIAL TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335 SW VIEWMOUNT CT
TIGARD OR
97223-3732
US

IV. Provider business mailing address

11335 SW VIEWMOUNT CT STE 240
TIGARD OR
97223-3732
US

V. Phone/Fax

Practice location:
  • Phone: 503-939-9459
  • Fax:
Mailing address:
  • Phone: 503-939-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMIRAT GURMU KANEA
Title or Position: PROVIDER
Credential:
Phone: 503-939-9459