NPIMap

Organization Active NPI

Fora Health Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
National Provider Identifier
1245378546
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FORA HEALTH INC.
Practice address
10230 SE Cherry Blossom Dr
Portland, OR 97216
Phone
(503) 535-1150
Fax
(503) 535-1190
NPI assigned
Feb 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Authorized official

Name
Mallory Juanita-Ann Johnson
Title
Contract Coordinator
Phone
(503) 535-1156

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X OR
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X OR
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X OR Primary
Adult Mental Health Clinic/Center 261QM0850X OR
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X OR
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X OR
Mental Illness Community Based Residential Treatment Facility 320800000X OR
Substance Abuse Rehabilitation Facility 324500000X OR
Children's Substance Abuse Rehabilitation Facility 3245S0500X OR

Addresses

Primary practice location

10230 SE Cherry Blossom Dr
Portland, OR 97216

Mailing address

P.O.Box 16040
Portland, OR 97292
Phone (503) 535-1150

Other identifiers 1

IdentifierTypeStateIssuer
299811MedicaidOR

Other names 1

  • DE PAUL TREATMENT CENTERS, INC. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260505003031 OR Part B Supplier - Clinic/Group Practice 8820566110 Receives reassigned benefits from 1 practitioner
Practice locations: Portland, OR

National Provider Directory

National Provider Directory
Tax ID family
Depaul Treatment Centers9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1320 SW Washington St
Portland, OR 97205
Phone (503) 535-1151

Practitioners & affiliated clinicians

Practitioners 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1245378546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O.BOX 16040",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97292",
            "telephone_number": "503-535-1150",
            "fax_number": "503-535-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10230 SE CHERRY BLOSSOM DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-535-1150",
            "fax_number": "503-535-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORA HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_middle_name": "JUANITA-ANN",
        "authorized_official_title_or_position": "CONTRACT COORDINATOR",
        "authorized_official_telephone_number": "503-535-1156"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299811",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DE PAUL TREATMENT CENTERS, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.