NPIMap

Organization Active NPI

Chronicles of Success Recovery Services LLC

  • Addiction (Substance Use Disorder) Counselor
  • Medford, OR
National Provider Identifier
1104765825
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
CHRONICLES OF SUCCESS RECOVERY SERVICES LLC
Practice address
3140 Juanipero Way Ste 101
Medford, OR 97504-8647
Phone
(541) 323-4800
Fax
(541) 508-0330
NPI assigned
Mar 27, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Authorized official

Name
Donique Boazeman, BOAZEMANNPI 1528955622
Title
Owner/Administrator
Phone
(313) 977-2767

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
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

3140 Juanipero Way Ste 101
Medford, OR 97504-8647

Mailing address

3140 Juanipero Way Ste 101
Medford, OR 97504-8647
Phone (541) 323-4800

National Provider Directory

National Provider Directory
Tax ID family
Chronicles of Success Recovery Services LLC2 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 6

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": "1774569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1104765825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3140 JUANIPERO WAY STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048647",
            "telephone_number": "541-323-4800",
            "fax_number": "541-508-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3140 JUANIPERO WAY STE 101",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048647",
            "telephone_number": "541-323-4800",
            "fax_number": "541-508-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRONICLES OF SUCCESS RECOVERY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-27",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "BOAZEMAN",
        "authorized_official_first_name": "DONIQUE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "313-977-2767",
        "authorized_official_credential": "BOAZEMAN"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.