Organization · Type 2 NPI

Elderly and Disabled Services

Mental Illness Community Based Residential Treatment Facility · Beaverton, OR

NPI number 1417764077 Active

Practice location

995 SW 178th Pl
Beaverton, OR 97003-7504

Call (458) 225-9358 Map

Mailing address

3126 State St Ste 100
Medford, OR 97504-8665

Specialties and licenses

Taxonomy	Code	License
Mental Illness Community Based Residential Treatment Facility Primary	320800000X	None listed

Mental Illness Community Based Residential Treatment Facility: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Another provider at this address

Christopher GuzmanCase Manager/Care Coordinator Beaverton, OR NPI 1326834961

Other mental illness community based residential treatment facility providers in Beaverton

See all in Beaverton →

NPI record

NPI: 1417764077
Entity type: Organization (Type 2)
Issued: Dec 16, 2024
Last updated: Feb 19, 2025
Status: Active
Subpart: Yes of Elderly and Disabled Services

Other names

<unavail>
Restoration Home Willow Creek · doing business as
Restoration Home Willow Creek · doing business as

Authorized official

Mr. Larry Michael McPhee
Owner/provider
(541) 261-1991

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1417764077

Elderly and Disabled Services's National Provider Identifier is 1417764077, issued on Dec 16, 2024. The primary taxonomy on file is Mental Illness Community Based Residential Treatment Facility (320800000X), and the practice location is in Beaverton, OR. The record was last updated on Feb 19, 2025.