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Columbiacare Services

Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Portland, OR

NPI 1225329014 · NPPES record last updated Apr 27, 2011

Key facts

NPI
1225329014
Entity type
Organization (NPI type 2)
Primary specialty
Mental Illness Community Based Residential Treatment Facility 320800000X
License
200012 (OR)
Legal business name
COLUMBIACARE SERVICES
Practice address
15208 SE Tibbetts St
Portland, OR 97236-2356
Phone
(503) 760-0959
Fax
(503) 761-0041
NPI assigned
Apr 27, 2011
Organization subpart
No

Authorized official

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

Corporate family (same tax ID) 41

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

View all 41

Practitioners 20

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

National Provider Directory

Tax ID family
Columbiacare Services Inc (42 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 200012 OR Yes

Addresses

Primary practice location

15208 SE Tibbetts St
Portland, OR 97236-2356

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170

Other identifiers

IdentifierTypeStateIssuer
518374OtherORCENTENIAL SERVICE PMT

Other names

  • Centenial Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 27, 2011.

{
    "created_epoch": "1303862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1225329014",
    "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": "541-858-8170",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15208 SE TIBBETTS ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972362356",
            "telephone_number": "503-760-0959",
            "fax_number": "503-761-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIACARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-27",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "BECKETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOE",
        "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": "200012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTENIAL SERVICE PMT",
            "identifier": "518374",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centenial",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

All providers in Portland, OR · Mental Illness Community Based Residential Treatment Facility in Oregon

Sources for this page

Verify at the official NPI Registry.