Power House Detox
Organization Active NPI Substance Use Disorder Rehabilitation Hospital Unit · Otis, OR
NPI 1982197182 · NPPES record last updated Jun 16, 2018
Key facts
- NPI
- 1982197182
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Hospital Unit 276400000X
- License
- 700119 (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
- Organization subpart
- Yes
- Parent organization (as reported)
- THE POWER HOUSE RESIDENTIAL DRUG TREATMENT CENTER INC
Authorized official
- Name
- Melissa Kim Homan, CADC II, CRM
- Title
- Regional Director
- Phone
- (541) 720-4636
Parent organization (reported in NPPES) 1
Practitioners 14
-
Regina Andrea Diel-Harley, CADC I, CRM
-
Renee Diane Ford, CADC-R
-
Amanda Maree Freeman, CADC-R
-
Christine Ann Massingale, CADC I
-
Sheila Ruth Petersen, CADC-R
-
Dana Ruby Vargas, CADC-R
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Hospital Unit | 276400000X | 700119 | OR | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500667339 | Medicaid | OR |
Other names
- PHD
Other providers in Otis, OR
- Cynthia J. Luxford
- Christine Ann Massingale
- Jamayca Jasmine Nelson
- Nova Vida Midwives, LLC
- Sheila Ruth Petersen
- Brandie Marie Randleman
- April Samantha Thompson
- Dana Ruby Vargas
- Jeb Zartman
All providers in Otis, OR · Substance Use Disorder Rehabilitation Hospital Unit in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.