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General NPI Number Information
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NPI Number | 1053223271
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Entity Type | Organization
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Legal Business Name | DESIRE RTH LLC
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 6030 SE MCNARY RD
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City | MILWAUKIE
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State | OR
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Zip | 97267-5115
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Country | US
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Telephone | 206-886-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 SE MCNARY RD
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City | MILWAUKIE
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State | OR
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Zip | 97267-5115
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Country | US
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Telephone | 206-886-2176
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | ANTENEH T NIGUSSIE
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Credential |
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Telephone | 206-886-2176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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