Organization
CALM HAVEN PDX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILSON KISAMBIRA KISAMBIRA (MANAGER)
(781) 309-8976
Entity
Organization
Contact information
Practice address
711 NE 172ND AVE, PORTLAND, OR 97230-6420
(458) 262-4514
Mailing address
711 NE 172ND AVE, PORTLAND, OR 97230-6420
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/13/2025
Last updated
01/13/2025
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