Healthcare Provider Details

I. General information

NPI: 1063962579
Provider Name (Legal Business Name): CHAISE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 SE SAINT HELENS ST STE 100F
CLACKAMAS OR
97015-6800
US

IV. Provider business mailing address

10117 SE SUNNYSIDE RD # F1217
CLACKAMAS OR
97015-7708
US

V. Phone/Fax

Practice location:
  • Phone: 503-740-1971
  • Fax: 503-771-2436
Mailing address:
  • Phone: 503-740-1971
  • Fax: 503-771-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL3197
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE L KRUMMENACKER
Title or Position: CEO
Credential:
Phone: 503-740-1971