Provider Demographics
NPI:1164300224
Name:GODEBO, GETACHEW ABULE
Entity type:Individual
Prefix:MR
First Name:GETACHEW
Middle Name:ABULE
Last Name:GODEBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16221 SE VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4720
Mailing Address - Country:US
Mailing Address - Phone:971-369-2990
Mailing Address - Fax:
Practice Address - Street 1:16221 SE VINEYARD LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4720
Practice Address - Country:US
Practice Address - Phone:971-369-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness