PACIFIC CREST TRAIL DETOX LLC (NPI# 1043760838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043760838 |
| Entity Type | Organization |
| Organization Name | PACIFIC CREST TRAIL DETOX LLC |
| Practice Address |
7708 Se Clackamas Rd Milwaukie OR 97267-4405 |
| Mailing Address |
10600 Se Mcloughlin Blvd 207 Milwaukie OR 97222-7428 |
| Practice Telephone | 5039088875 |
| Mailing Telephone | 8557700577 |
| Mailing Fax Number | 5036541852 |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2016-10-05 |
| Authorized Official Name | BENJAMIN RANDOLPH (CEO) |
| Authorized Official Telephone | 5039011836 |
| Authorized Official Credential | MS, CADCIII |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
7708 SE CLACKAMAS RD |
| City | MILWAUKIE |
| State | OR |
| Zip Code | 97267-4405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851911036 | Michelle Renee Gilham | Massage Therapist | 16560 S.e. 80th Ave, Portland Or 97267, 19650 Se 80th Ave, Portland, OR 97267 | 2020-04-17 |
| 1629557442 | Benchmark Physical Therapy of Or, LLC | Occupational Therapist | 14874 Se Webster Rd, Milwaukie, OR 97267 | 2018-08-13 |
| 1326541764 | Theresa Elaine Day | Massage Therapist | 2080 Se Oak Grove Blvd Ste 16, Portland, OR 97267 | 2018-03-12 |
| 1881015378 | Kathryn Louise Engstrom | Registered Nurse | 6901 Se Lake Road, Portland, OR 97267 | 2013-12-30 |
| 1285951293 | Eliza Ann Rowley | Acupuncturist | 2080 Se Oak Grove Blvd #9, Milwaukie, OR 97267 | 2010-04-29 |
| 1346438124 | Rx Direct Inc | Pharmacy | 16246 Se Mcloughlin, Milwaukie, OR 97267 | 2007-10-05 |
| 1477740827 | Olson Drug, Inc | Durable Medical Equipment & Medical Supplies | 16244 Se Mcloughlin Blvd, Milwaukie, OR 97267 | 2007-10-01 |
| 1831308451 | Jeannie Marie Baer | Massage Therapist | 16705 Se Mcloughlin, Milwaukie, OR 97267 | 2007-05-21 |
| 1902923667 | Matthew William Krueger | Specialist/Technologist | 4950 Se Roethe Rd., Milwaukie, OR 97267 | 2007-03-26 |
| 1316084049 | Renee' Lorena Raschke | Counselor | 17070se Mcloughlin Blvd., Milwaukie, OR 97267 | 2007-01-31 |
| Find all providers in zip 97267 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194175067 | Oregon Trail Recovery | Substance Abuse Rehabilitation Facility | 10600 Se Mcloughlin Blvd, 200, Milwaukie, OR 97222-7428 | 2016-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669000865 | Mid-valley Healthcare, Inc. | Substance Abuse Rehabilitation Facility | 111 N Main St Ste B, Lebanon, OR 97355-2869 | 2020-04-01 |
| 1548822216 | Oregon Recovery Behavioral Health | Substance Abuse Rehabilitation Facility | 1184 Mcgee Ct Ne Ste 200, Keizer, OR 97303-9443 | 2019-07-02 |
| 1972011682 | Women's Enrichment Counseling | Substance Abuse Rehabilitation Facility | 1300 John Adams St Ste 103, Oregon City, OR 97045-1691 | 2018-01-16 |
| 1356851042 | Debra Monaghan | Substance Abuse Rehabilitation Facility | 1271 Sw 9th St, Warrenton, OR 97146-9418 | 2017-10-06 |
| 1619429396 | Serenity Lane | Substance Abuse Rehabilitation Facility | 304 Dartmoor Drive, Eugene, OR 97401 | 2016-10-28 |
| 1477002228 | Treehouse Nw Inc | Substance Abuse Rehabilitation Facility | 4713 N Albina Ave, Suite 301, Portland, OR 97217-2605 | 2016-09-21 |
| 1154785475 | Blvd Centers, Inc | Substance Abuse Rehabilitation Facility | 1316 Se 12th Ave, Portland, OR 97214-3604 | 2016-04-12 |
| 1851757454 | Circle of Trust Healing Center, LLC | Substance Abuse Rehabilitation Facility | 3300 Butler Creek Rd, Ashland, OR 97520-9173 | 2016-01-12 |
| 1700258258 | La Pine Ktc, LLC | Substance Abuse Rehabilitation Facility | 16161 Burgess Rd, La Pine, OR 97739-9533 | 2015-10-23 |
| 1669849212 | Ava Center Inc. | Substance Abuse Rehabilitation Facility | 75 Nw Ava Ave, Gresham, OR 97030-7019 | 2015-08-31 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PACIFIC CREST TRAIL DETOX LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.