Healthcare Provider Details

I. General information

NPI: 1447167267
Provider Name (Legal Business Name): THE RECOVERY VILLAGE OREGON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 LANCASTER DR NE
SALEM OR
97301-4687
US

IV. Provider business mailing address

2200 N COMMERCE PKWY STE 200
WESTON FL
33326-3258
US

V. Phone/Fax

Practice location:
  • Phone: 754-300-3120
  • Fax: 888-919-4431
Mailing address:
  • Phone: 754-300-3120
  • Fax: 888-919-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BELINA SURUJON
Title or Position: VP CONTRACTING & LICENSING
Credential:
Phone: 305-785-5520