Rose City Drug & Alcohol Detox Center of Portland LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

ROSE CITY DRUG & ALCOHOL DETOX CENTER OF PORTLAND LLC

Practice address

12711 SE Holgate Blvd
Portland, OR 97236-3734

Phone

(503) 896-8232

NPI assigned

Dec 4, 2024

Organization subpart

No

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

Authorized official

Name

Mr. William Ray Anderson, CIP

Title

Executive Director/ Ownership

Phone

(503) 896-8232

Specialties & licenses 1

Addresses

Other names 1

• Rose City Detox Other name

Locations

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

{
    "created_epoch": "1733270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733270400000",
    "number": "1932915063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 SW BARBUR BLVD STE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972196853",
            "telephone_number": "503-896-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12711 SE HOLGATE BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363734",
            "telephone_number": "503-896-8232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE CITY DRUG & ALCOHOL DETOX CENTER OF PORTLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-04",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/ OWNERSHIP",
        "authorized_official_telephone_number": "503-896-8232",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CIP"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rose City Detox",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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 Dec 4, 2024; 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.