NPIMap

Organization Active NPI

Coffee Creek Correction Facility

  • Multi-Specialty Clinic/Center
  • Portland, OR
National Provider Identifier
1619397767
Registry record updated Apr 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
COFFEE CREEK CORRECTION FACILITY
Practice address
847 NE 19TH Ave
Suite 100
Portland, OR 97232-2684
Phone
(503) 238-0769
Fax
(503) 963-7711
NPI assigned
Apr 16, 2014
Organization subpart
Yes
Parent organization
CASCADIA BEHAVIORAL HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2014

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

Authorized official

Name
Dr. Derald Walker, PHD
Title
President / Ceo
Phone
(503) 238-0769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

847 NE 19TH Ave
Suite 100
Portland, OR 97232-2684

Mailing address

847 NE 19TH Ave
Suite 100
Portland, OR 97232-2684
Phone (503) 238-0769

Other names 1

  • Turning Point Program Other name

National Provider Directory

National Provider Directory
Tax ID family
Wellspring67 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397606400000",
    "number": "1619397767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-238-0769",
            "fax_number": "503-963-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "847 NE 19TH AVE",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322684",
            "telephone_number": "503-238-0769",
            "fax_number": "503-963-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE CREEK CORRECTION FACILITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASCADIA BEHAVIORAL HEALTHCARE, INC.",
        "enumeration_date": "2014-04-16",
        "last_updated": "2014-04-16",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "DERALD",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "503-238-0769",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Turning Point Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2014; 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.