Provider Demographics
NPI:1003789066
Name:MASADA 1 CORPORATION
Entity type:Organization
Organization Name:MASADA 1 CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GOBENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIFU
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:971-261-8518
Mailing Address - Street 1:8982 SE SCOTTSTREE WAY
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8535
Mailing Address - Country:US
Mailing Address - Phone:971-261-8518
Mailing Address - Fax:503-305-6268
Practice Address - Street 1:980 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1730
Practice Address - Country:US
Practice Address - Phone:871-261-8517
Practice Address - Fax:503-305-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility