The Recovery Village Oregon, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

THE RECOVERY VILLAGE OREGON, LLC

Practice address

309 Lancaster Dr NE
Salem, OR 97301-4687

Phone

(754) 300-3120

Fax

(888) 919-4431

NPI assigned

Jun 6, 2025

Organization subpart

No

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

Authorized official

Name

Belina Surujon

Title

VP Contracting & Licensing

Phone

(305) 785-5520

Specialties & licenses 2

Addresses

Other names 1

• The Recovery Village Salem Drug, Alcohol and Mental Health Rehab Doing business as

Tax ID family

The Recovery Village Oregon LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• The Recovery Village Oregon, LLC

  • Substance Abuse Rehabilitation Facility
  • Salem, OR
  • NPI 1497699250
  NPD tax ID

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

{
    "created_epoch": "1749168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1477447183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SE 3RD AVE STE 1800",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333940011",
            "telephone_number": "305-785-5520",
            "fax_number": "888-919-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014687",
            "telephone_number": "754-300-3120",
            "fax_number": "888-919-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RECOVERY VILLAGE OREGON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-06",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "SURUJON",
        "authorized_official_first_name": "BELINA",
        "authorized_official_title_or_position": "VP CONTRACTING & LICENSING",
        "authorized_official_telephone_number": "305-785-5520"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Recovery Village Salem Drug, Alcohol and Mental Health Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• The Recovery Village Oregon, LLC
• The Recovery Village Oregon, LLC
• The Shangri-la Corporation
• The Trauma Academy Northwest, LLC
• The Williamstopher Care LLC
• Lisa Dawn Theobald, PMHNP

• Substance Abuse Rehabilitation Facility in Salem, OR
• Providers in Salem, OR by specialty
• Substance Abuse Rehabilitation Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.