MEDICARE: PIONEER RTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1417822925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER RTH LLC

Provider Business Mailing Address
First Line	:	6941 SE BIXEL WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97267-4244
Country	:	US
Telephone Number	:	503-713-2151
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 SE BIXEL WAY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97267-4244
Country	:	US
Telephone Number	:	503-713-2151
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	YOHANNES DEMSSIE
Credential	:
Telephone Number	:	503-713-2151

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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