Healthcare Provider Details

I. General information

NPI: 1215488200
Provider Name (Legal Business Name): CRC HEALTH OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 NE 78TH CT STE A3
PORTLAND OR
97218-2823
US

IV. Provider business mailing address

6601 NE 78TH CT STE A3
PORTLAND OR
97218-2823
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-3949
  • Fax: 503-252-4027
Mailing address:
  • Phone: 503-252-3949
  • Fax: 503-252-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. FJESSE A JAMES
Title or Position: CTC DIRECTOR
Credential: CADC II
Phone: 503-252-3949