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General NPI Number Information
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NPI Number | 1205788502
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Entity Type | Organization
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Legal Business Name | CGCG II, INC
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 300 14TH ST SE
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City | SALEM
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State | OR
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Zip | 97301-6311
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Country | US
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Telephone | 503-508-9735
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Fax |
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Provider Business Mailing Address
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Address Line | 12955 SW OXALIS TER
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City | TIGARD
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State | OR
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Zip | 97223-5656
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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 | PRESIDENT
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Name | BRYAN CARROLL
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Credential |
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Telephone | 503-701-7931
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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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