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General NPI Number Information
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NPI Number | 1497699250
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Entity Type | Organization
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Legal Business Name | THE RECOVERY VILLAGE OREGON, LLC
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 309 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97301-4687
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Country | US
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Telephone | 305-785-5520
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Fax | 888-919-4431
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Provider Business Mailing Address
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Address Line | 2200 N COMMERCE PKWY STE 200
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City | WESTON
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State | FL
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Zip | 33326-3258
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Country | US
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Telephone | 305-785-5520
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Fax | 888-919-4431
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Authorized Official
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Title or Position | VP CONTRACTING & LICENSING
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Name | BELINA SURUJON
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Credential |
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Telephone | 305-785-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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