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General NPI Number Information
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NPI Number | 1174321657
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Entity Type | Organization
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Legal Business Name | AVALON WELLNESS LIVING LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 13205 SW WATKINS AVE
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City | TIGARD
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State | OR
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Zip | 97223-3870
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Country | US
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Telephone | 503-740-4522
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Fax | 971-246-5082
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Provider Business Mailing Address
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Address Line | 13205 SW WATKINS AVE
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City | TIGARD
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State | OR
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Zip | 97223-3870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAHEL MASRESHA
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Credential |
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Telephone | 503-740-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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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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