NPIMap

Organization Active NPI

West Linn Clementine, Inc

  • Adolescent and Children Mental Health Clinic/Center
  • West Linn, OR
National Provider Identifier
1023562147
Registry record updated Mar 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
WEST LINN CLEMENTINE, INC
Practice address
1148 Rosemont Rd
West Linn, OR 97068-9235
Phone
(971) 249-8448
Fax
(503) 305-7100
NPI assigned
Aug 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2020

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

Authorized official

Name
Mike Bagley
Title
Chief Financial Officer
Phone
(305) 663-1876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X OR Primary

Addresses

Primary practice location

1148 Rosemont Rd
West Linn, OR 97068-9235

Mailing address

6100 SW 76TH St
South Miami, FL 33143-5002
Phone (305) 663-1876

Other names 1

  • Clementine Portland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Psychiatric residential treatment facility certification: CCN 38L016

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CLEMENTINE WEST LINN
Certification status
Active
Provider type (POS)
Psychiatric residential treatment facility
Participating since
Aug 9, 2021
Last certification
Jul 19, 2023
Beds
12
Ownership / control type
Non-profit – corporation
Facility address
1148 Rosemont Road
West Linn, OR 97068

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
38D2128709Clementine West Linn1148 Rosemont Rd, West Linn, OR 97068Certificate of waiverApr 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Clementine Portland2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1023562147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SW 76TH ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435002",
            "telephone_number": "305-663-1876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1148 ROSEMONT RD",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970689235",
            "telephone_number": "971-249-8448",
            "fax_number": "503-305-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST LINN CLEMENTINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "BAGLEY",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "305-663-1876"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clementine Portland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clementine Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Linn, OR

Sources for this page

Verify at the official NPI Registry.