Provider Demographics
NPI:1801761705
Name:ELENIH GROUP HOME LLC
Entity type:Organization
Organization Name:ELENIH GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:HADISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-997-3557
Mailing Address - Street 1:3189 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-1467
Mailing Address - Country:US
Mailing Address - Phone:503-997-3557
Mailing Address - Fax:
Practice Address - Street 1:3189 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1467
Practice Address - Country:US
Practice Address - Phone:503-997-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities