NPIMap

Organization Active NPI

Columbacare Services

Doing business as Summit Residential South

  • Psychiatric Residential Treatment Facility
  • Springfield, OR
National Provider Identifier
1679073712
Registry record updated Feb 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
COLUMBACARE SERVICES
Doing business as
Summit Residential South
Practice address
622 57TH St
Springfield, OR 97478-6821
Phone
(541) 858-8170
NPI assigned
Feb 15, 2018
Last updated
Feb 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2018

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

Authorized official

Name
Michael Sewitsky
Title
Finance Director
Phone
(541) 858-8170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X
Psychiatric Residential Treatment Facility 323P00000X Primary

Addresses

Primary practice location

622 57TH St
Springfield, OR 97478-6821

Mailing address

3587 Heathrow Way
Medford, OR 97504-4004
Phone (541) 858-8170

Other names 1

  • Summit Residential South Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Columbacare Services42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518652800000",
    "number": "1679073712",
    "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",
            "fax_number": "541-858-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 57TH ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974786821",
            "telephone_number": "541-858-8170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBACARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-15",
        "last_updated": "2018-02-15",
        "status": "A",
        "authorized_official_last_name": "SEWITSKY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "541-858-8170"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Residential South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; 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.