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General NPI Number Information
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NPI Number | 1417898941
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Entity Type | Organization
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Legal Business Name | IMANI RESIDENTIAL TREATMENT HOME
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 14325 SW WILSON DR
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City | BEAVERTON
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State | OR
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Zip | 97008-6140
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Country | US
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Telephone | 971-357-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 14325 SW WILSON DR
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City | BEAVERTON
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State | OR
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Zip | 97008-6140
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Country | US
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Telephone | 971-357-1234
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. SUSAN MBUGUA
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Credential | PMHNP-BC
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Telephone | 214-458-1713
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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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