Organization
PATH LIGHT AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELIJAH N KARANJA (PROVIDER)
(503) 810-7879
Entity
Organization
Contact information
Practice address
526 SE 128TH AVE, PORTLAND, OR 97233-1602
(503) 810-7879
(971) 339-3946
Mailing address
526 SE 128TH AVE, PORTLAND, OR 97233-1602
(503) 810-7879
(971) 339-3946
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/04/2024
Last updated
07/30/2024
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