NPIMap

Organization Active NPI

Power House Detox

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Otis, OR
National Provider Identifier
1982197182
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X
License
700119 Issued in OR
Legal business name
POWER HOUSE DETOX
Practice address
3955 Salmon River Hwy
Otis, OR 97368-9778
Phone
(541) 720-4636
Fax
(888) 977-2106
NPI assigned
Jun 12, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
THE POWER HOUSE RESIDENTIAL DRUG TREATMENT CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Melissa Kim Homan, CADC II, CRM
Title
Regional Director
Phone
(541) 720-4636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X 700119 OR Primary

Addresses

Primary practice location

3955 Salmon River Hwy
Otis, OR 97368-9778

Mailing address

3955 Salmon River Hwy
Otis, OR 97368-9778
Phone (541) 720-4636

Other names 1

  • PHD Other name

National Provider Directory

National Provider Directory
Part of
The Power House Residential Drug Treatment Center Inc

Locations

3955 Salmon River Hwy
Otis, OR 97368
Phone (541) 614-4437

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1528761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1982197182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 SALMON RIVER HWY",
            "city": "OTIS",
            "state": "OR",
            "postal_code": "973689778",
            "telephone_number": "541-720-4636",
            "fax_number": "888-977-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 SALMON RIVER HWY",
            "city": "OTIS",
            "state": "OR",
            "postal_code": "973689778",
            "telephone_number": "541-720-4636",
            "fax_number": "888-977-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWER HOUSE DETOX",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE POWER HOUSE RESIDENTIAL DRUG TREATMENT CENTER INC",
        "enumeration_date": "2018-06-12",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "HOMAN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "541-720-4636",
        "authorized_official_credential": "CADC II, CRM"
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "OR",
            "license": "700119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Otis, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.