COLUMBIACARE SERVICES (NPI# 1508126368) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1508126368 |
Entity Type | Organization |
Organization Name | COLUMBIACARE SERVICES |
Other Organization Name | JENNINGS LODGE |
Practice Address |
3587 Heathrow Way Medford OR 97504-4004 |
Mailing Address |
4545 Se Ina Ave Milwaukie OR 97267-5916 |
Practice Telephone | 5418588170 |
Mailing Telephone | 5418588170 |
Enumeration Date | 2012-05-25 |
Last Update Date | 2012-05-25 |
Authorized Official Name | MR. ROBERT BECKETT (EXECUTIVE DIRECTOR) |
Authorized Official Telephone | 5418588170 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
Jennings Lodge | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427553692 | Columbiacare Services | Clinic/Center | 29415 Russell St, Gold Beach, OR 97444 | 2018-03-28 |
1255835104 | Columbiacare Services | Clinic/Center | 850 Swing Ln, Medford, OR 97501-1790 | 2018-03-23 |
1982140588 | Columbiacare Services | Clinic/Center | 17720 Ne Halsey St # 1, Portland, OR 97230-6734 | 2017-01-06 |
1831640192 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 8336 Highway 62, White City, OR 97530 | 2016-10-20 |
1871946640 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 29841 Hillcrest St, Gold Beach, OR 97444-8714 | 2016-07-18 |
1194173898 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 410 Maple St, Brookings, OR 97415 | 2016-06-03 |
1679941785 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 130 Se 119th Ave, Portland, OR 97216-3704 | 2015-09-04 |
1346637816 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 17710 Halsey Crc, Portland, OR 97230 | 2015-04-22 |
1700273638 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 17700 Ne Halsey St, Portland, OR 97230-6734 | 2015-04-17 |
1740679182 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 11380 Se Greenburg Rd #9, Tigard, OR 97223 | 2015-01-22 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Washington State Corporations | COLUMBIACARE SERVICES, INC | 3587 Heathrow Way, Medford, OR 97504 |
Oregon Corporations, Companies and Business Names | COLUMBIACARE SERVICES, INC. | 3587 Heathrow Way, Medford, OR 97504 |
Street Address |
3587 HEATHROW WAY |
City | MEDFORD |
State | OR |
Zip Code | 97504-4004 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104962471 | Gaelen Laurel Thurow | Counselor | 3587 Heathrow Way, Medford, OR 97504-4004 | 2007-01-30 |
1841837796 | Anastasia Olga Zukowski | Counselor | 3587 Heathrow Way, Medford, OR 97504-4004 | 2019-12-10 |
1497227995 | Gary J Mcconahay | Counselor | 3587 Heathrow Way, Medford, OR 97504-4004 | 2018-12-20 |
1689144750 | Kirby Douglas Rider | Case Management | 3587 Heathrow Way, Medford, OR 97504-4004 | 2018-11-30 |
1174002091 | Tiffany A Weldon | Registered Nurse | 3587 Heathrow Way, Medford, OR 97504-4004 | 2018-08-10 |
1265965354 | Joseph Chick | Counselor | 3587 Heathrow Way, Medford, OR 97504-4004 | 2017-04-06 |
1992245625 | Columbiacare Services | Clinic/Center | 3587 Heathrow Way, Suite #1, Medford, OR 97504-4004 | 2017-02-28 |
1750826616 | Columbiacare Services | Case Management | 3587 Heathrow Way, Medford, OR 97504-4004 | 2017-01-03 |
1972047660 | Zola Hulet | Case Manager/Care Coordinator | 3587 Heathrow Way, Medford, OR 97504-4004 | 2016-12-14 |
1710421540 | Stephanie Lynn Lane | Case Manager/Care Coordinator | 3587 Heathrow Way, Medford, OR 97504-4004 | 2016-12-13 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
Find all providers in zip 97504 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508218553 | Columbiacare Serices | Community Based Residential Treatment Facility, Mental Illness | 1998 Sky Park Dr Ste 102, Medford, OR 97504-5395 | 2016-07-01 |
1003262106 | Catholic Charities Diocese of Trenton | Community Based Residential Treatment Facility, Mental Illness | 417 Tabernacle Rd, Medford, NJ 08055-2019 | 2016-05-06 |
1750780227 | Westbridge Inc | Community Based Residential Treatment Facility, Mental Illness | 275 Mystic Ave, Ste C, Medford, MA 02155-6301 | 2014-08-20 |
1780966606 | Walgreens | Community Based Residential Treatment Facility, Mental Illness | 113 Monument St, Medford, MA 02155-3538 | 2011-09-16 |
1134270341 | Laurel Hill Inn, Ltd | Community Based Residential Treatment Facility, Mental Illness | 121 Mystic St, Medford, MA 02155-3463 | 2007-01-15 |
1861918278 | Columbiacare Services Inc | Community Based Residential Treatment Facility, Mental Illness | 2016 Terrel Dr, Medford, OR 97501-8154 | 2017-08-17 |
1548511694 | Options for Southern Oregon | Community Based Residential Treatment Facility, Mental Illness | 1911 Hazel Ave, Medford, OR 97501-1630 | 2012-09-28 |
1104186014 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3587 Heathrow Way, Medford, OR 97504-4004 | 2012-05-24 |
1780988253 | Jackson County Mental Health | Community Based Residential Treatment Facility, Mental Illness | 1911 Hazel Ave, Medford, OR 97501-1630 | 2010-12-27 |
1649466475 | Columbiacare Services Inc | Community Based Residential Treatment Facility, Mental Illness | 3587 Heathrow Way, Medford, OR 97504 | 2007-09-14 |
Find all providers in MEDFORD |
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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.