NPIMap

Organization Active NPI

Elderly and Disabled Services

Doing business as Restoration Home Willow Creek

  • Mental Illness Community Based Residential Treatment Facility
  • Beaverton, OR
National Provider Identifier
1417764077
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
ELDERLY AND DISABLED SERVICES
Doing business as
Restoration Home Willow Creek
Practice address
995 SW 178TH PL
Beaverton, OR 97003-7504
Phone
(458) 225-9358
NPI assigned
Dec 16, 2024
Last updated
Feb 19, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ELDERLY AND DISABLED SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Mr. Larry Michael McPheeNPI 1164000170
Title
Owner/Provider
Phone
(541) 261-1991

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

995 SW 178TH PL
Beaverton, OR 97003-7504

Mailing address

3126 State St Ste 100
Medford, OR 97504-8665
Phone (458) 225-9358

Other names 1

  • Restoration Home Willow Creek Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elderly and Disabled Services7 organizations share this tax ID, including this one
Part of
Elderly and Disabled Services

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1734307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1417764077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3126 STATE ST STE 100",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048665",
            "telephone_number": "458-225-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 SW 178TH PL",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970037504",
            "telephone_number": "458-225-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERLY AND DISABLED SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELDERLY AND DISABLED SERVICES",
        "enumeration_date": "2024-12-16",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "MCPHEE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "541-261-1991",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restoration Home Willow Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Restoration Home Willow Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; 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.