Provider Demographics
NPI:1720829898
Name:KARANJA, ELIJAH
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:KARANJA
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 1:526 SE 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1602
Mailing Address - Country:US
Mailing Address - Phone:503-810-7879
Mailing Address - Fax:971-339-3946
Practice Address - Street 1:526 SE 128TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1602
Practice Address - Country:US
Practice Address - Phone:503-810-7879
Practice Address - Fax:971-339-3946
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRTF100092320800000X
OR320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness