NPIMap

Organization Active NPI

Pacific Crest Trail Detox LLC

  • Substance Abuse Rehabilitation Facility
  • Milwaukie, OR
National Provider Identifier
1043760838
Registry record updated Oct 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
PACIFIC CREST TRAIL DETOX LLC
Practice address
7708 SE Clackamas Rd
Milwaukie, OR 97267-4405
Phone
(503) 908-8875
NPI assigned
Oct 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2016

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

Authorized official

Name
Benjamin Randolph, MS, CADCIIINPI 1225252612
Title
Ceo
Phone
(503) 901-1836

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

7708 SE Clackamas Rd
Milwaukie, OR 97267-4405

Mailing address

10600 SE McLoughlin Blvd
207
Milwaukie, OR 97222-7428
Phone (855) 770-0577

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1475625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475625600000",
    "number": "1043760838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 SE MCLOUGHLIN BLVD",
            "address_2": "207",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227428",
            "telephone_number": "855-770-0577",
            "fax_number": "503-654-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7708 SE CLACKAMAS RD",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972674405",
            "telephone_number": "503-908-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CREST TRAIL DETOX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-05",
        "last_updated": "2016-10-05",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "503-901-1836",
        "authorized_official_credential": "MS, CADCIII"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.