Provider Demographics
NPI:1942036561
Name:FELICIFICARE DOMUS SALUTIS LLC
Entity type:Organization
Organization Name:FELICIFICARE DOMUS SALUTIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEMECHIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABDISSA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP CANDIDATE
Authorized Official - Phone:971-431-6436
Mailing Address - Street 1:380 NE 178TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6658
Mailing Address - Country:US
Mailing Address - Phone:971-431-6436
Mailing Address - Fax:
Practice Address - Street 1:380 NE 178TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6658
Practice Address - Country:US
Practice Address - Phone:971-274-2724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility