Provider Demographics
NPI:1740072081
Name:PLEASANT VALLEY RTH LLC
Entity type:Organization
Organization Name:PLEASANT VALLEY RTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-753-3515
Mailing Address - Street 1:2722 NE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1603
Mailing Address - Country:US
Mailing Address - Phone:253-753-3515
Mailing Address - Fax:
Practice Address - Street 1:1875 SW EASTWOOD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-9784
Practice Address - Country:US
Practice Address - Phone:253-753-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility