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NPI Code Detail

MEDICARE: FELICIFICARE DOMUS SALUTIS LLC

MEDICARE: FELICIFICARE DOMUS SALUTIS 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
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1942036561
Entity Type Code : Organization
Provider Name (Legal Business Name) : FELICIFICARE DOMUS SALUTIS LLC
Provider Business Mailing Address
First Line : 11125 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97220-2555
Country : US
Telephone Number : 971-431-6436
Fax Number :
Provider Business Practice Location Address
First Line : 11125 NE SANDY BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97220-2555
Country : US
Telephone Number : 971-431-6436
Fax Number :
Authorized Official
Title or Position : CEO
Name : GEMECHIS G ABDISSA
Credential : PMHNP CANDIDATE
Telephone Number : 971-431-6436
Provider Enumeration Date : 09/10/2024
Last Update Date : 12/15/2025

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Directions to “FELICIFICARE DOMUS SALUTIS LLC ” Practice Location

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