Columbiacare Services

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

810609831 Issued in OR

Legal business name

COLUMBIACARE SERVICES

Practice address

3587 Heathrow Way
Medford, OR 97504-4004

Phone

(541) 858-8170

NPI assigned

May 24, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Robert Beckett

Title

Executive Director

Phone

(541) 858-8170

Specialties & licenses 1

Addresses

Other names 1

• Lincoln Park Doing business as

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

{
    "created_epoch": "1337817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1104186014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 SE 139TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972332041",
            "telephone_number": "541-858-8170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3587 HEATHROW WAY",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044004",
            "telephone_number": "541-858-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIACARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-24",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "ROBERT",
        "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": "OR",
            "license": "810609831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lincoln Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julio Colon
• Joyce Margaret Colosimo, COTA
• Columbacare Services
• Columbiacare Serices
• Columbiacare Services
• Columbiacare Services
• Columbiacare Services
• Columbiacare Services
• Columbiacare Services
• Columbiacare Services

• All providers in Medford, OR
• Mental Illness Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; 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.