Portland Detox

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

AC01151 Issued in OR

Legal business name

PORTLAND DETOX

Practice address

11160 SW Waverly PL
Portland, OR 97225-4456

Phone

(503) 750-6238

NPI assigned

Mar 24, 2009

Organization subpart

No

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

Authorized official

Name

Brad Whisnant, LACNPI 1164608717

Title

Owner

Phone

(503) 750-6238

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Brad Harold Whisnant, LAC

  • Acupuncturist
  • Portland, OR
  • NPI 1164608717
  NPD (past) Authorized official

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1649412511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11160 SW WAVERLY PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254456",
            "telephone_number": "503-750-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 SW WAVERLY PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254456",
            "telephone_number": "503-750-6238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND DETOX",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-24",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "WHISNANT",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-750-6238",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OR",
            "license": "AC01151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Portland Dental Center
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• Portland Dental Works, LLC (Portland Dental Works)
• Portland Dermatology Clinic, LLP
• Portland Diabetes & Endocrinology (Portland Diabetes & Endocrinology Center, P C)
• Portland Dialectical Behavior Therapy PC
• Portland Doctor, LLC
• Portland Dysphagia Diagnostics LLC
• Portland Ear Nose & Throat

• Substance Abuse Rehabilitation Facility in Portland, OR
• Providers in Portland, 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 Mar 24, 2009; 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.