Healthcare Provider Details

I. General information

NPI: 1891605820
Provider Name (Legal Business Name): SACRED PATH COMPASSION & RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HORSESHOE DR
GRANTS PASS OR
97526-7822
US

IV. Provider business mailing address

315 HORSESHOE DR
GRANTS PASS OR
97526-7822
US

V. Phone/Fax

Practice location:
  • Phone: 458-226-0017
  • Fax:
Mailing address:
  • Phone: 458-226-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHNATHAN T STILLWAGON
Title or Position: OWNER
Credential: CRM, PSS, CHW, HCW,
Phone: 458-226-0017