Organization
CASCADIABHC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSIE JEROME ISAAC NON-CREDENTIALED COU (RESIDENTIAL COUNCELOR)
(503) 771-6061
Entity
Organization
Contact information
Practice address
7511 SE HENRY ST, PORTLAND, OR 97206-6445
(503) 771-6061
Mailing address
3608 SE 40TH AVE APT 3, PORTLAND, OR 97202-1769
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
OR
Other
Enumeration date
03/07/2007
Last updated
08/22/2020
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