Provider Demographics
NPI:1912889809
Name:WILLAMETTE WELLNESS HOME CARE LLC
Entity type:Organization
Organization Name:WILLAMETTE WELLNESS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:NZITONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NSENGIYUMVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-928-0598
Mailing Address - Street 1:13700 SW 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3773
Mailing Address - Country:US
Mailing Address - Phone:503-928-0598
Mailing Address - Fax:
Practice Address - Street 1:13700 SW 114TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-3773
Practice Address - Country:US
Practice Address - Phone:503-928-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness