Organization
AETERNUM CARE LLC
Active
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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