NPIMap

Organization Active NPI

Oregon Trail Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Milwaukie, OR
National Provider Identifier
1881010502
Registry record updated Apr 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
OREGON TRAIL RECOVERY LLC
Practice address
10600 SE McLoughlin Blvd
Ste 207
Milwaukie, OR 97222-7428
Phone
(503) 901-1836
NPI assigned
Mar 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2015

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

Authorized official

Name
Benjamin RandolphNPI 1225252612
Title
Owner
Phone
(503) 901-1836

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
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

10600 SE McLoughlin Blvd
Ste 207
Milwaukie, OR 97222-7428

Mailing address

10600 SE McLoughlin Blvd
Ste 207
Milwaukie, OR 97222-7428

Other names 1

  • Clean Adventures of Oregon Former legal business name

National Provider Directory

National Provider Directory

Locations

10600 SE McLoughlin Blvd
Ste 207
Portland, OR 97222
Phone (503) 901-1836

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430179200000",
    "number": "1881010502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 SE MCLOUGHLIN BLVD",
            "address_2": "STE 207",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10600 SE MCLOUGHLIN BLVD",
            "address_2": "STE 207",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227428",
            "telephone_number": "503-901-1836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OREGON TRAIL RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-06",
        "last_updated": "2015-04-28",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-901-1836"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clean Adventures of Oregon",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Milwaukie, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; 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.