Columbiacare Services
Organization Active NPI Psychiatric Residential Treatment Facility · Portland, OR
NPI 1588069801 · NPPES record last updated Oct 29, 2014
Key facts
- NPI
- 1588069801
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Residential Treatment Facility 323P00000X
- Legal business name
- COLUMBIACARE SERVICES
- Practice address
- 17640 NE Halsey St
Portland, OR 97230-6733 - Phone
- (541) 858-8170
- NPI assigned
- Oct 29, 2014
- 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 |
|---|---|---|---|---|
| Psychiatric Residential Treatment Facility | 323P00000X | Yes |
Addresses
Primary practice location
17640 NE Halsey St
Portland, OR 97230-6733
Mailing address
3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170
NPI Registry JSON
{
"created_epoch": "1414540800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1414540800000",
"number": "1588069801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3587 HEATHROW WAY",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975044004",
"telephone_number": "541-858-8170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17640 NE HALSEY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972306733",
"telephone_number": "541-858-8170"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COLUMBIACARE SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-29",
"last_updated": "2014-10-29",
"status": "A",
"authorized_official_last_name": "SEWITSKY",
"authorized_official_first_name": "MIKE",
"authorized_official_middle_name": "DAVID",
"authorized_official_title_or_position": "FINANCE MANAGER",
"authorized_official_telephone_number": "541-858-8170"
},
"taxonomies": [
{
"code": "323P00000X",
"taxonomy_group": "",
"desc": "Psychiatric Residential Treatment Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
- Columbiacare Services
All providers in Portland, 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 Oct 29, 2014. 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.