Organization
RESPONSIBLE DECISIONS
Active
Organization
RESPONSIBLE DECISIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRELL GRAY CRM, CADC APPLICANT (OWNER)
(503) 744-9180
Entity
Organization
Contact information
Practice address
150 NE 3RD AVE, HILLSBORO, OR 97124-3150
(503) 744-9180
Mailing address
150 NE 3RD AVE, HILLSBORO, OR 97124-3150
(503) 744-9180
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
10/09/2018
Last updated
10/09/2018
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