Healthcare Provider Details

I. General information

NPI: 1114067410
Provider Name (Legal Business Name): FAMILY RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 NW 4TH ST
CORVALLIS OR
97330-6491
US

IV. Provider business mailing address

442 NW 4TH ST
CORVALLIS OR
97330-6491
US

V. Phone/Fax

Practice location:
  • Phone: 541-738-6832
  • Fax: 541-738-6410
Mailing address:
  • Phone: 541-738-6832
  • Fax: 541-738-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA-159
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL S. HANSON
Title or Position: OUTPATIENT PROGRAM MANAGER
Credential: MS, CADC II
Phone: 541-757-7534