NPIMap

Organization Active NPI

Telecare Mental Health Services of Oregon, Inc

Doing business as 72nd Ave Recovery Center

  • Mental Illness Community Based Residential Treatment Facility
  • Portland, OR
National Provider Identifier
1659453686
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
TELECARE MENTAL HEALTH SERVICES OF OREGON, INC
Doing business as
72nd Ave Recovery Center
Practice address
7759 SE 72ND Ave
Portland, OR 97206-7921
Phone
(503) 788-4500
Fax
(503) 788-4506
NPI assigned
Oct 19, 2006
Last updated
May 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Authorized official

Name
Lorena Lopez
Title
Provider Relations Supervisor
Phone
(510) 337-7950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary

Addresses

Primary practice location

7759 SE 72ND Ave
Portland, OR 97206-7921

Mailing address

1080 Marina Village Pkwy Ste 100
Alameda, CA 94501-1078
Phone (510) 337-7950

Other names 1

  • 72nd Ave Recovery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070618000058 OR Part B Supplier - Clinic/Group Practice 1557460524 Receives reassigned benefits from 7 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Woodburn, OR; Gresham, OR; Bend, OR

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2253536Telecare 72ND Ave Recovery Center7759 SE 72ND Ave, Portland, OR 97206Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
Telecare Mental Health of Oregon18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684281600000",
    "number": "1659453686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 MARINA VILLAGE PKWY STE 100",
            "city": "ALAMEDA",
            "state": "CA",
            "postal_code": "945011078",
            "telephone_number": "510-337-7950",
            "fax_number": "510-337-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7759 SE 72ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972067921",
            "telephone_number": "503-788-4500",
            "fax_number": "503-788-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELECARE MENTAL HEALTH SERVICES OF OREGON, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "LORENA",
        "authorized_official_title_or_position": "PROVIDER RELATIONS SUPERVISOR",
        "authorized_official_telephone_number": "510-337-7950"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "72nd Ave Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "72nd Ave Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.