Organization
GIFTED SOUL RESIDENTIAL HOME LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAFAWO YADETO (EXECUTIVE DIRECTOR)
(360) 990-5579
Entity
Organization
Contact information
Practice address
1128 SE 141ST AVE, PORTLAND, OR 97233-2218
(503) 206-5980
(503) 447-4702
Mailing address
1128 SE 141ST AVE, PORTLAND, OR 97233-2218
(503) 206-5980
(503) 447-4702
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/15/2026
Last updated
01/15/2026
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