BH-Or Opco 109TH, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

BH-OR OPCO 109TH, LLC

Doing business as

Jackson House Portland SRTF 109th

Practice address

2566 SE 109TH Ave
Portland, OR 97266-1215

Phone

(503) 504-4042

NPI assigned

Sep 19, 2024

Organization subpart

No

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

Authorized official

Name

Chad Engbrecht

Title

General Counsel

Phone

(858) 254-2510

Specialties & licenses 1

Addresses

Other names 1

• Jackson House Portland SRTF 109th Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726704000000",
    "number": "1427885722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12125",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972120125",
            "telephone_number": "503-504-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 SE 109TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972661215",
            "telephone_number": "503-504-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BH-OR OPCO 109TH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "ENGBRECHT",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "858-254-2510"
    },
    "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": "Jackson House Portland SRTF 109th",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Marie Bezanson, LPC
• Grace Marie Bezek
• Heather Jean Bezold
• Samuel Bezzant
• BH-Or Op MLK, LLC
• Nicole Bhalerao, D.C.
• Shireesh Bhalerao, D.C.
• Mona Bhalla, N.D.
• Castigliano M Bhamidipati, DO, PHD, MSC
• Sonia Ashika Bhan

• Mental Illness Community Based Residential Treatment Facility in Portland, OR
• Providers in Portland, OR by specialty
• Mental Illness Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.