Organization
AETERNUM CARE LLC
Active
Other names
AETERNUM CARE LLC, Carebridge
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON PAUL KISAMBIRA (DIRECTOR)
(781) 309-8976
Entity
Organization
Contact information
Practice address
613 SE 32ND AVE, HILLSBORO, OR 97123-7311
(458) 262-4514
Mailing address
613 SE 32ND AVE, HILLSBORO, OR 97123-7311
(458) 262-4514
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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