NPIMap

Organization Active NPI

Reclaim Life, LLC

  • Clinical Social Worker
  • Albany, OR
National Provider Identifier
1043788896
Registry record updated Apr 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
RECLAIM LIFE, LLC
Practice address
425 2ND Ave SW Ste 102
Albany, OR 97321-2483
Phone
(541) 286-3209
Fax
(541) 704-0040
NPI assigned
Nov 9, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2020

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

Authorized official

Name
Deidre Lafferty, LCSWNPI 1386099398
Title
Owner, Therapist
Phone
(541) 286-3209

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

425 2ND Ave SW Ste 102
Albany, OR 97321-2483

Mailing address

425 2ND Ave SW Ste 102
Albany, OR 97321-2483
Phone (541) 286-3209

Other identifiers 1

IdentifierTypeStateIssuer
500763687MedicaidOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190618003620 OR Part B Supplier - Clinic/Group Practice 7416293493 Receives reassigned benefits from 8 practitioners
Practice locations: Albany, OR

National Provider Directory

National Provider Directory

Locations

2300 14th Ave SE
Albany, OR 97322
Phone (541) 600-3939

425 2nd Ave SW
Ste 101B
Albany, OR 97321

425 2nd Ave SW
Ste 102
Albany, OR 97321
Phone (541) 286-3209

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586649600000",
    "number": "1043788896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 2ND AVE SW STE 102",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212483",
            "telephone_number": "541-286-3209",
            "fax_number": "541-704-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 2ND AVE SW STE 102",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973212483",
            "telephone_number": "541-286-3209",
            "fax_number": "541-704-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECLAIM LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2020-04-12",
        "certification_date": "2020-04-12",
        "status": "A",
        "authorized_official_last_name": "LAFFERTY",
        "authorized_official_first_name": "DEIDRE",
        "authorized_official_title_or_position": "OWNER, THERAPIST",
        "authorized_official_telephone_number": "541-286-3209",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500763687",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.