Organization
ADULT POSTIVE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMION JOHNSON (OWNER)
(503) 749-5760
Entity
Organization
Contact information
Practice address
2355 STATE ST STE 101, SALEM, OR 97301-4541
(503) 749-5760
Mailing address
5852 NE AINSWORTH ST, PORTLAND, OR 97218-2354
(503) 752-7638
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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