Organization
MAV RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAHAD FARAH (CEO)
(651) 226-4132
Entity
Organization
Contact information
Practice address
3750 S RIVER PKWY APT 325, PORTLAND, OR 97239-4746
(651) 226-4132
Mailing address
3750 S RIVER PKWY APT 325, PORTLAND, OR 97239-4746
(651) 226-4132
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/29/2024
Last updated
02/29/2024
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