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General NPI Number Information
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NPI Number | 1205791324
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Entity Type | Organization
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Legal Business Name | WILLAMETTE LIVING GROUP LLC
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 1466 SW 5TH PL
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City | GRESHAM
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State | OR
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Zip | 97080-6828
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Country | US
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Telephone | 503-891-5648
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 LAVONA DR NW
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City | SALEM
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State | OR
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Zip | 97304-3744
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Country | US
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Telephone | 503-891-5648
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | PHILLIP M HUBER
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Credential |
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Telephone | 503-891-5648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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