PACIFIC CREST TRAIL DETOX LLC


Address: 7708 Se Clackamas Rd, Milwaukie, OR 97267-4405
Phone: 5039088875

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 324500000X Substance Abuse Rehabilitation Facility Residential Treatment Facilities

Office Location

Street Address 7708 SE CLACKAMAS RD
City MILWAUKIE
State OR
Zip Code 97267-4405

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 324500000X
Grouping Residential Treatment Facilities
Classification Substance Abuse Rehabilitation Facility

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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
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Competitor

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City MILWAUKIE
Zip Code 97267

Improve Information

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Dataset Information

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.

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