# GIFTED SOUL RESIDENTIAL HOME LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396604468
- **Authorized official:** SAFAWO YADETO (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (360) 990-5579

## Contact information

- **Practice address:** 1128 SE 141ST AVE, PORTLAND, OR 97233-2218
- **Practice address phone:** (503) 206-5980
- **Practice address fax:** (503) 447-4702
- **Mailing address:** 1128 SE 141ST AVE, PORTLAND, OR 97233-2218
- **Mailing address phone:** (503) 206-5980
- **Mailing address fax:** (503) 447-4702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/15/2026
- **Last updated:** 01/15/2026