NPIMap

Organization Active NPI

Mid-Valley Healthcare, Inc.

Doing business as Samaritan Behavioral Health & Recovery Clinic - Lebanon

  • Addiction Medicine (Family Medicine) Physician
  • Lebanon, OR
National Provider Identifier
1003362922
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X
Legal business name
MID-VALLEY HEALTHCARE, INC.
Doing business as
Samaritan Behavioral Health & Recovery Clinic - Lebanon
Practice address
100 Mullins Dr Ste C1
Lebanon, OR 97355-2868
Phone
(541) 451-7450
NPI assigned
Aug 31, 2016
Last updated
Feb 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Rackham
Title
Ceo-SLCH
Phone
(541) 768-6768

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Clinical Social Worker 1041C0700X NU
Addiction Medicine (Family Medicine) Physician 207QA0401X NU Primary
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X NU

Addresses

Primary practice location

100 Mullins Dr Ste C1
Lebanon, OR 97355-2868

Mailing address

100 Mullins Dr Ste C1
Lebanon, OR 97355-2868
Phone (541) 451-7450

Other names 1

  • Samaritan Behavioral Health & Recovery Clinic - Lebanon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000297 OR Part B Supplier - Clinic/Group Practice 2769391523 Receives reassigned benefits from 458 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lebanon, OR; Sweet Home, OR; Newport, OR; Halsey, OR; Brownsville, OR

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2146334Samaritan Behavioral Health & Recovery - Lebanon100 Mullins Dr Ste C1, Lebanon, OR 97355Certificate of waiverMar 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lebanon Emergency Physi12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1003362922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MULLINS DR STE C1",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552868",
            "telephone_number": "541-451-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MULLINS DR STE C1",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552868",
            "telephone_number": "541-451-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-31",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "RACKHAM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO-SLCH",
        "authorized_official_telephone_number": "541-768-6768"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Behavioral Health & Recovery Clinic - Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.