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Individual

TADESSE MELKA MOJO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7980 SW GREENHOUSE LN, PORTLAND, OR 97225-3868
(971) 224-9404
Mailing address
7980 SW GREENHOUSE LN, PORTLAND, OR 97225-3868
(971) 224-9404

Taxonomy

Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
320700000X
Physical Disabilities Residential Treatment Facility
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
05/30/2025
Last updated
06/08/2025
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