NPIMap

Organization Active NPI

Columbia Care Services

Doing business as Bridgestone

  • Mental Illness Community Based Residential Treatment Facility
  • Wilsonville, OR
National Provider Identifier
1073885141
Registry record updated Feb 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
COLUMBIA CARE SERVICES
Doing business as
Bridgestone
Practice address
29549 SW Villebois Dr S
Wilsonville, OR 97070-7329
Phone
(503) 427-0172
Fax
(503) 427-0798
NPI assigned
Feb 3, 2012
Last updated
Feb 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2012

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

Authorized official

Name
Mr. Robert C Beckett
Title
Executive Director
Phone
(541) 858-8170

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary
Psychiatric Residential Treatment Facility 323P00000X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

29549 SW Villebois Dr S
Wilsonville, OR 97070-7329

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 585-8170

Other names 1

  • Bridgestone Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170420001277 OR Part B Supplier - Clinic/Group Practice 6901182229 Receives reassigned benefits from 15 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, OR

Other NPIs on the same Medicare enrollment 32

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

View all 32

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1328227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328227200000",
    "number": "1073885141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044004",
            "telephone_number": "541-585-8170",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29549 SW VILLEBOIS DR S",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970707329",
            "telephone_number": "503-427-0172",
            "fax_number": "503-427-0798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-03",
        "last_updated": "2012-02-03",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-858-8170",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgestone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilsonville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2012; 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.