OREGON TRAIL RECOVERY LLC (NPI# 1881010502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881010502 |
| Entity Type | Organization |
| Organization Name | OREGON TRAIL RECOVERY LLC |
| Other Organization Name | CLEAN ADVENTURES OF OREGON |
| Practice Address |
10600 Se Mcloughlin Blvd Ste 207 Milwaukie OR 97222-7428 |
| Practice Telephone | 5039011836 |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2015-04-28 |
| Authorized Official Name | BENJAMIN RANDOLPH (OWNER) |
| Authorized Official Telephone | 5039011836 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Clean Adventures of Oregon | Former Legal Business Name - Organization |
| Street Address |
10600 SE MCLOUGHLIN BLVD STE 207 |
| City | MILWAUKIE |
| State | OR |
| Zip Code | 97222-7428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912059601 | Heather M Harris | Specialist | 10600 Se Mcloughlin Blvd, Suite 206, Milwaukie, OR 97222-7428 | 2007-01-16 |
| 1194175067 | Oregon Trail Recovery | Substance Abuse Rehabilitation Facility | 10600 Se Mcloughlin Blvd, 200, Milwaukie, OR 97222-7428 | 2016-06-21 |
| 1871929588 | Nanci J Doherty | Massage Therapist | 10600 Se Mcloughlin Blvd, #102, Milwaukie, OR 97222-7428 | 2013-09-26 |
| 1063765824 | Katherine Reece Vernon | Occupational Therapist | 10600 Se Mcloughlin Blvd, Ste 202, Milwaukie, OR 97222-7428 | 2012-10-17 |
| 1528329513 | Wellspring Massage LLC | Massage Therapist | 10600 Se Mcloughlin Blvd, Suite 102, Milwaukie, OR 97222-7428 | 2012-06-06 |
| 1477826691 | Brandi Anne Burland | Chiropractor | 10600 Se Mcloughlin Blvd, Suite 101, Milwaukie, OR 97222-7428 | 2012-02-18 |
| 1790083947 | Samantha Rose Mohn | Specialist | 10600 Se Mcloughlin Blvd, Suite 202, Milwaukie, OR 97222-7428 | 2011-03-10 |
| 1730483256 | Judith Claire Buonforte | Occupational Therapist | 10600 Se Mcloughlin Blvd, Suite 202, Milwaukie, OR 97222-7428 | 2010-12-23 |
| 1053620708 | Jmb Caregiving Services, Inc. | In Home Supportive Care | 10600 Se Mcloughlin Blvd, Suite 212, Milwaukie, OR 97222-7428 | 2010-09-29 |
| 1598078149 | Gwendolyn Shearer | Massage Therapist | 10600 Se Mcloughlin Blvd, Suite 206, Milwaukie, OR 97222-7428 | 2010-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831731397 | Madalyn Kelly Yowell | Technician | 7809 Southeast Southgate Street, Milwaukee, OR 97222 | 2019-10-16 |
| 1336617448 | Nadia Yang | Social Worker | 2115 Se Adams St, Milwaukie, OR 97222 | 2018-11-06 |
| 1851892368 | Arrow Dental LLC | Dentist | 10505 Se 17th Avenue, Milwaukie, OR 97222 | 2018-02-21 |
| 1851814016 | Cathy Maria Andrew | Acupuncturist | 11022 Se Stanley Ave, Milwaukie, OR 97222 | 2017-07-19 |
| 1972025369 | Sarah Elizabeth Giles | Peer Specialist | 11097 Se 21st Ave., Milwaukie, OR 97222 | 2017-07-07 |
| 1366976292 | Brittany Reubendale | Physical Therapist | 12705 See River Rd, Portland, OR 97222 | 2017-04-18 |
| 1669916383 | Margie Hertz | Registered Nurse | 6406 Se Cedarcrest Drive, Milwaukie, OR 97222 | 2016-12-14 |
| 1952858094 | Alexis Escobar | Speech-Language Pathologist | 4560 Se International Way, Ste 100, Milwaukie, OR 97222 | 2016-09-07 |
| 1205295466 | Beth Ann Mills | Acupuncturist | 2025 Se Jefferson St Ste 106, Milwaukie, OR 97222 | 2016-02-16 |
| 1558744086 | Kyle Eugene Coan | Specialist | 3306 Se Wister St, Milwaukie, OR 97222 | 2015-07-01 |
| Find all providers in zip 97222 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952940298 | New Start Program | Clinic/Center | 12180 Se Market St, Portland, OR 97216-3923 | 2020-01-03 |
| 1992204697 | Sober Living Oregon Treatment Center | Clinic/Center | 10209 Se Division, Portland, OR 97266 | 2018-02-08 |
| 1851835722 | Changepoint, Inc | Clinic/Center | 1700 Nw 167th Place, Suite 240, Beaverton, OR 97006 | 2016-12-13 |
| 1518419779 | Bend Iop | Clinic/Center | 20354 Empire Ave, Bend, OR 97703-5710 | 2016-11-03 |
| 1447605258 | Crestview Recovery Services, LLC | Clinic/Center | 6027 Se Belmont St, Portland, OR 97215-1927 | 2016-04-29 |
| 1669856571 | Portland Iop, LLC | Clinic/Center | 748 Se 181st Ave, Portland, OR 97233-4945 | 2015-07-10 |
| 1194150326 | Goforth Inspired LLC | Clinic/Center | 345 Ne Baker Creek Rd, Mcminnville, OR 97128-2019 | 2013-09-06 |
| 1376788729 | Total Results LLC | Clinic/Center | 251 Ne Garden Valley Blvd, Suite I, Roseburg, OR 97470-1498 | 2008-12-12 |
| 1225241441 | Crc Health Oregon, LLC | Clinic/Center | 777 Murphy Rd, Medford, OR 97504-8425 | 2007-05-07 |
| 1336287010 | Seasons Counseling, Inc | Clinic/Center | 730 Hawthorne Ave Ne, Salem, OR 97301-4674 | 2007-02-02 |
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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.