Organization · Type 2 NPI

Imani Residential Treatment Home

Mental Illness Community Based Residential Treatment Facility · Beaverton, OR

NPI number 1417898941 Active

Practice location

14325 SW Wilson Dr
Beaverton, OR 97008-6140

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.

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NPI record

NPI: 1417898941
Entity type: Organization (Type 2)
Issued: Apr 1, 2026
Last updated: Apr 1, 2026
Status: Active
Subpart: Yes of Imani Mental Health and Wellness LLC

Other names

Imani Residential Treatment Home · doing business as

Authorized official

Ms. Susan Mbugua, PMHNP-BC
Adminstrator
(214) 458-1713

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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.

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About NPI 1417898941

Imani Residential Treatment Home's National Provider Identifier is 1417898941, issued on Apr 1, 2026. 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 Apr 1, 2026.