MEDICARE: THE RECOVERY VILLAGE OREGON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1477447183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RECOVERY VILLAGE OREGON, LLC

Provider Business Mailing Address
First Line	:	100 SE 3RD AVE STE 1800
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33394-0011
Country	:	US
Telephone Number	:	305-785-5520
Fax Number	:	888-919-4431

Provider Business Practice Location Address
First Line	:	309 LANCASTER DR NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-4687
Country	:	US
Telephone Number	:	754-300-3120
Fax Number	:	888-919-4431

Authorized Official
Title or Position	:	VP CONTRACTING & LICENSING
Name	:	BELINA SURUJON
Credential	:
Telephone Number	:	305-785-5520

Provider Enumeration Date	:	06/06/2025
Last Update Date	:	06/06/2025

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Directions to “THE RECOVERY VILLAGE OREGON, LLC ” Practice Location

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