Organization
BH-OR OPCO 109TH, LLC
Active
Other names
Jackson House Portland SRTF 109th
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD ENGBRECHT (GENERAL COUNSEL)
(858) 254-2510
Entity
Organization
Contact information
Practice address
2566 SE 109TH AVE, PORTLAND, OR 97266-1215
(503) 504-4042
Mailing address
PO BOX 12125, PORTLAND, OR 97212-0125
(503) 504-4042
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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