Columbacare Services
Organization Active NPI Psychiatric Residential Treatment Facility · Brookings, OR
NPI 1518201151 · NPPES record last updated Nov 20, 2012
Key facts
- NPI
- 1518201151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Residential Treatment Facility 323P00000X
- License
- 07863 (OR)
- Legal business name
- COLUMBACARE SERVICES
- Practice address
- 210 Cove Lane
Brookings, OR 97415 - Phone
- (541) 858-8170
- NPI assigned
- Nov 20, 2012
- Organization subpart
- No
Authorized official
- Name
- Mike David Sewitsky
- Title
- Finance Manager
- Phone
- (541) 858-8170
Other NPIs on the same Medicare enrollment 32
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170420001277 | OR | Part B Supplier - Clinic/Group Practice | 6901182229 |
Receives reassigned benefits from 15 practitioners 32 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Medford, OR |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 07863 | OR | |
| Psychiatric Residential Treatment Facility | 323P00000X | 07863 | OR | Yes |
Addresses
Primary practice location
210 Cove Lane
Brookings, OR 97415
Mailing address
3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170
Other providers in Brookings, OR
- Coastal Home Health & Hospice Inc.
- Brandon Cole
- Bryan Gene Collard
- Shannon Alyse Collard
- Cheryl Marie Collier
- Columbiacare Services
- Ashley Cook
- Diana Lacy Cooper
- Costa Clinical Psychology, LLC
- Teresa Ione Costa
All providers in Brookings, OR · Psychiatric Residential Treatment Facility in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.