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General NPI Number Information
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NPI Number | 1407219157
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Entity Type | Organization
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Legal Business Name | CRC HEALTH OREGON
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 6185 PASEO DEL NORTE STE 150
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City | CARLSBAD
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State | CA
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Zip | 92011-1152
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Country | US
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Telephone | 855-259-2288
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Fax | 760-918-8712
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Provider Business Mailing Address
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Address Line | 6601 NE 78TH CT SUITE A-3
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City | PORTLAND
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State | OR
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Zip | 97218-2823
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Country | US
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Telephone | 503-252-3949
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Fax |
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Authorized Official
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Title or Position | NURSE SUPERVISOR
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Name | NICOLE ROSE ANN SMITH
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Credential | LPN
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Telephone | 503-252-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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