NPIMap

Organization Active NPI

Nibbus Combined Care LLC

Doing business as Brycen's House RTH

  • Mental Illness Community Based Residential Treatment Facility
  • Phoenix, OR
National Provider Identifier
1730987462
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
NIBBUS COMBINED CARE LLC
Doing business as
Brycen's House RTH
Practice address
805 Amerman Dr
Phoenix, OR 97535-7729
Phone
(458) 291-1603
NPI assigned
Mar 6, 2025
Last updated
Mar 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
NIBBUS COMBINED CARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Authorized official

Name
Brenda WatsonNPI 1275991788
Title
Owner/Executive Director
Phone
(458) 225-9993

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

805 Amerman Dr
Phoenix, OR 97535-7729

Mailing address

1175 E Main St Ste 2F
Medford, OR 97504-7457
Phone (458) 225-9993

Other names 1

  • Brycen's House RTH Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nibbus Combined Care LLC Dba New Wave RTH7 organizations share this tax ID, including this one
Part of
Nibbus Combined Care LLC Dba New Wave RTH

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1741219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1730987462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 E MAIN ST STE 2F",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047457",
            "telephone_number": "458-225-9993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 AMERMAN DR",
            "city": "PHOENIX",
            "state": "OR",
            "postal_code": "975357729",
            "telephone_number": "458-291-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIBBUS COMBINED CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NIBBUS COMBINED CARE LLC",
        "enumeration_date": "2025-03-06",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "458-225-9993"
    },
    "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": "Brycen's House RTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.