Individual
TESFAYE GOMALO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4436 JADE ST NE, SALEM, OR 97305-2233
(971) 258-6432
Mailing address
4436 JADE ST NE, SALEM, OR 97305-2233
(971) 258-6432
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
RTH100295
OR
Other
Enumeration date
01/13/2026
Last updated
01/13/2026
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