Vernon Rose Jr., CADC II

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

07-09-64 Issued in OR

Practice address

4211 W 11TH Ave
Eugene, OR 97402-5435

Phone

(541) 485-1577

Fax

(541) 242-2853

NPI assigned

Mar 21, 2017

Last updated

Oct 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1356872477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 W 11TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025435",
            "telephone_number": "541-485-1577",
            "fax_number": "541-242-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 W 11TH AVE",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025435",
            "telephone_number": "541-485-1577",
            "fax_number": "541-242-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "VERNON",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CADC II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "07-09-64",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500730386",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED ALCOHOL AND DRUG COUNSELOR LEVEL II",
            "identifier": "07-09-64",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hope V Rose
• Jillian Rose, D.M.D.
• Joanna Rose, LMT
• Rebecca Rose
• Sharon Dee Rose, CHIROPRACTIC ASSISTA
• Willow Ann Rose, LPC, NCC
• Yahsolait Rose, LE
• Zachary Rose, L.D.
• Roseburg Healthcare System
• Roseburg VA Healthcare System

• Addiction (Substance Use Disorder) Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; 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.