Provider Demographics
NPI:1558233148
Name:INCREDIBLE RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:INCREDIBLE RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEMECHU
Authorized Official - Middle Name:
Authorized Official - Last Name:JORJORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-491-3964
Mailing Address - Street 1:2246 SE 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2021
Mailing Address - Country:US
Mailing Address - Phone:702-491-3964
Mailing Address - Fax:503-894-8787
Practice Address - Street 1:2246 SE 90TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2021
Practice Address - Country:US
Practice Address - Phone:702-491-3964
Practice Address - Fax:503-894-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health