Healthcare Provider Details

I. General information

NPI: 1083010094
Provider Name (Legal Business Name): RECOVERY WORKS NW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 08/19/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 SW MAIN ST STE 202
TIGARD OR
97223-6198
US

IV. Provider business mailing address

12540 SW MAIN ST STE 202
TIGARD OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-9995
  • Fax: 503-597-7000
Mailing address:
  • Phone: 503-906-9995
  • Fax: 503-597-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMI MCBRIDE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 503-906-9995