Organization
JANUS YOUTH PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CALVIN D GRIGGS (COUNSELOR)
(503) 841-4393
Entity
Organization
Contact information
Practice address
142 SE 160TH AVE APT 24, PORTLAND, OR 97233-3558
(503) 841-4393
Mailing address
142 SE 160TH AVE APT 24, PORTLAND, OR 97233-3558
(503) 841-4393
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/02/2014
Last updated
05/02/2014
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