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General NPI Number Information
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NPI Number | 1689573719
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Entity Type | Organization
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Legal Business Name | DTY RESIDENTIAL TREATMENT HOME
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Dates
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Enumeration Date | 11/04/2026
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Last Update Date | 11/04/2026
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Provider Practice Location Address
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Address Line | 668 NE 21ST AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-3529
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Country | US
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Telephone | 651-621-4416
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Fax | 971-246-8388
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Provider Business Mailing Address
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Address Line | 668 NE 21ST AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-3529
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Country | US
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Telephone | 651-621-4416
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Fax | 971-246-8388
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DEREJE SEYOUM
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Credential |
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Telephone | 651-621-4416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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