64TH AVE LLC NPI 1912152570

NPI Information

NPI: 1912152570
Provider Name: 64TH AVE LLC

Doing Business As: KING RD RTF

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
4199 SE KING RD
MILWAUKIE, OR
ZIP 97222
Phone: (503) 786-3830
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64TH AVE LLC is a community based residential treatment facility mental illness in Milwaukie, OR. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. 64TH AVE LLC NPI is 1912152570. The provider is registered as an organization entity type.
The provider Is Doing Business As King Rd Rtf.

The provider's business location address is:

4199 SE KING RD
MILWAUKIE, OR
ZIP 97222-892
Phone: (503) 786-3830
Fax: (503) 653-3534

The provider's authorized official is Rhonda L Schoenborn .
The authorized official title is Managing Member/owner and has the following contact phone number (503) 786-3830.

The enumeration date for this NPI number is 11/24/2008 and was last updated on 11/24/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		869	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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