| Organization Name: | PARKSIDE LIVING RTF |
| NPI Number: | 1447405147 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | POONEH ENTEZARI (OWNER) |
| Mailing Address: | 1525 Sw Shirley Ann Dr Mcminnville |
| State: | OR US |
| Postal Code: | 971287665 |
| Phone Number: | 5034729603 |
| Fax Number: | |
| NPI Enumeration Date: | 11/21/2008 |
| NPI Last Update Date: | 11/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |