Family Residential Treatment Home

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

FAMILY RESIDENTIAL TREATMENT HOME

Practice address

4436 Jade St NE
Salem, OR 97305-2233

Phone

(971) 258-6432

NPI assigned

Jan 22, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Dixon

Title

Administrator

Phone

(971) 719-3141

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tesfaye Gomalo

  • Mental Illness Community Based Residential Treatment Facility
  • Salem, OR
  • NPI 1255299749

  Community Based Residential Treatment Facility, Mental Illness

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769040000000",
    "number": "1972452159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4436 JADE ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973052233",
            "telephone_number": "971-258-6432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4436 JADE ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973052233",
            "telephone_number": "971-258-6432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY RESIDENTIAL TREATMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-22",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "971-719-3141"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlos Falcon
• Elizabeth Maria Falletta, RN
• Family Building Blocks
• Family Focus Eye Care LLC
• Family Medicine LLC
• Robert S Fan, MD
• Nervin Hafez Fanous, MD
• John Lee Fant, CADC I
• Antoinette Farah, M.D.
• Anja D Farin, CPM, LDM

• Mental Illness Community Based Residential Treatment Facility in Salem, OR
• Providers in Salem, OR by specialty
• Mental Illness Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.