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General NPI Number Information
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NPI Number | 1801711072
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Entity Type | Organization
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Legal Business Name | STAG CREST PATHWAYS LLC
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 5541 S MACADAM AVE # 6426
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 971-200-5126
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Fax |
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Provider Business Mailing Address
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Address Line | 5541 S MACADAM AVE # 6426
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 971-200-5126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDIFATAH JAMA
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Credential |
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Telephone | 971-200-5126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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