Organization
64TH AVE LLC
Active
Organization
64TH AVE LLC
Active
Other names
King Rd RTF
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA L SCHOENBORN (MANAGING MEMBER/OWNER)
(503) 786-3830
Entity
Organization
Contact information
Practice address
4199 SE KING RD, MILWAUKIE, OR 97222-5892
(503) 786-3830
(503) 653-3534
Mailing address
4199 SE KING RD, MILWAUKIE, OR 97222-5892
(503) 786-3830
(503) 653-3534
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
869
OR
Other
Enumeration date
11/24/2008
Last updated
11/24/2008
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