NPIMap

Organization Active NPI

Renaissance Recovery Resources, Inc.

Doing business as Oregon Recovery Behavioral Health

  • Community/Behavioral Health Agency
  • Lake Oswego, OR
National Provider Identifier
1124800891
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
RENAISSANCE RECOVERY RESOURCES, INC.
Doing business as
Oregon Recovery Behavioral Health
Practice address
5775 Jean Rd Ste 104
Lake Oswego, OR 97035-5311
Phone
(503) 304-4358
Fax
(503) 304-4361
NPI assigned
Oct 18, 2023
Last updated
Dec 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
RENAISSANCE RECOVERY RESOURCES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Justin Scott Nielsen, CADC IINPI 1124324330
Title
Executive Director
Phone
(503) 304-4358

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5775 Jean Rd Ste 104
Lake Oswego, OR 97035-5311

Mailing address

PO Box 20674
Keizer, OR 97307-0674
Phone (503) 304-4358

Other names 1

  • Oregon Recovery Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oregon Recovery Behavioral Health7 organizations share this tax ID, including this one
Part of
Oregon Recovery Behavioral Health

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5775 Jean Rd
Ste 104
Lake Oswego, OR 97035
Phone (503) 304-4358

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1124800891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20674",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973070674",
            "telephone_number": "503-304-4358",
            "fax_number": "503-304-4361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5775 JEAN RD STE 104",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970355311",
            "telephone_number": "503-304-4358",
            "fax_number": "503-304-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE RECOVERY RESOURCES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RENAISSANCE RECOVERY RESOURCES, INC.",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-304-4358",
        "authorized_official_credential": "CADC II"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oregon Recovery Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oregon Recovery Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Oswego, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.