Individual
ALEKSANDR BAHMATOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
U
Contact information
Practice address
17821 SE ARISTA DR, MILWAUKIE, OR 97267-6036
(971) 386-8671
Mailing address
17821 SE ARISTA DR, MILWAUKIE, OR 97267-6036
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
OR
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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