NPIMap

Organization Active NPI

Jasper Mountain

  • Mental Illness Community Based Residential Treatment Facility
  • Jasper, OR
National Provider Identifier
1497821680
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
JASPER MOUNTAIN
Practice address
37875 Jasper Lowell Rd
Jasper, OR 97438-9751
Phone
(541) 747-1235
Fax
(541) 747-4722
NPI assigned
Nov 28, 2006
Last updated
Mar 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Authorized official

Name
Carita Chantel Lively
Title
Compliance Specialist
Phone
(541) 747-1235

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X OR Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X OR
Psychiatric Residential Treatment Facility 323P00000X
Child Mental Illness Respite Care 385HR2055X OR

Addresses

Primary practice location

37875 Jasper Lowell Rd
Jasper, OR 97438-9751

Mailing address

37875 Jasper Lowell Rd
Jasper, OR 97438-9751
Phone (541) 747-1235

Other identifiers 2

IdentifierTypeStateIssuer
178087MedicaidOR
313495MedicaidOR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 366

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 366

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1497821680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37875 JASPER LOWELL RD",
            "city": "JASPER",
            "state": "OR",
            "postal_code": "974389751",
            "telephone_number": "541-747-1235",
            "fax_number": "541-747-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37875 JASPER LOWELL RD",
            "city": "JASPER",
            "state": "OR",
            "postal_code": "974389751",
            "telephone_number": "541-747-1235",
            "fax_number": "541-747-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JASPER MOUNTAIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "LIVELY",
        "authorized_official_first_name": "CARITA",
        "authorized_official_middle_name": "CHANTEL",
        "authorized_official_title_or_position": "COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "541-747-1235"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OR",
            "license": null,
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "178087",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "313495",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.