NPIMap

Organization Active NPI

Kairos Northwest

  • Mental Illness Community Based Residential Treatment Facility
  • Grants Pass, OR
National Provider Identifier
1366865495
Registry record updated Jan 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
KAIROS NORTHWEST
Practice address
210 Tacoma St
Grants Pass, OR 97526-9370
Phone
(541) 467-3302
NPI assigned
Jan 24, 2014
Last updated
Jan 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2014

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

Authorized official

Name
Mrs. Susan Boldt, M.SNPI 1396052775
Title
Operations Director
Phone
(541) 474-5579

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

210 Tacoma St
Grants Pass, OR 97526-9370

Mailing address

715 SW Ramsey Ave
Grants Pass, OR 97527-5500
Phone (541) 956-4943

National Provider Directory

National Provider Directory
Tax ID family
Kairos3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/kairosnw/r4/

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390521600000",
    "number": "1366865495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975275500",
            "telephone_number": "541-956-4943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 TACOMA ST",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975269370",
            "telephone_number": "541-467-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAIROS NORTHWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-24",
        "last_updated": "2014-01-24",
        "status": "A",
        "authorized_official_last_name": "BOLDT",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "541-474-5579",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.