# CALM HAVEN PDX LLC

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

## Provider details

- **NPI number:** 1841000767
- **Authorized official:** WILSON KISAMBIRA KISAMBIRA (MANAGER)
- **Authorized official phone:** (781) 309-8976

## Contact information

- **Practice address:** 711 NE 172ND AVE, PORTLAND, OR 97230-6420
- **Practice address phone:** (458) 262-4514
- **Mailing address:** 711 NE 172ND AVE, PORTLAND, OR 97230-6420

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | — |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/13/2025
- **Last updated:** 01/13/2025