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General NPI Number Information
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NPI Number | 1619760717
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Entity Type | Organization
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Legal Business Name | MERCY BRIDGE RESIDENTIAL TREATMENT LLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1050 SW 160TH AVE APT 338
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City | BEAVERTON
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State | OR
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Zip | 97006-5017
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Country | US
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Telephone | 616-644-4312
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 SW 206TH AVE
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City | BEAVERTON
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State | OR
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Zip | 97078-3743
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Country | US
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Telephone | 616-644-4312
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMMANUEL ZEWDE
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Credential |
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Telephone | 616-644-4312
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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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