NPIMap

Organization Active NPI

Madrona Recovery

  • Psychiatric Residential Treatment Facility
  • Tigard, OR
National Provider Identifier
1992238091
Registry record updated Jun 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
MADRONA RECOVERY
Practice address
7000 SW Varns St
Tigard, OR 97223-8145
Phone
(949) 293-2351
NPI assigned
Apr 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2019

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

Authorized official

Name
Micah Brady Braithwaite
Title
Coo/Cfo
Phone
(503) 749-0200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X Primary
Substance Abuse Rehabilitation Facility 324500000X OR

Addresses

Primary practice location

7000 SW Varns St
Tigard, OR 97223-8145

Mailing address

7000 SW Varns St
Tigard, OR 97223-8145
Phone (503) 749-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Psychiatric residential treatment facility certification: CCN 38L017

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MADRONA RECOVERY
Certification status
Active
Provider type (POS)
Psychiatric residential treatment facility
Participating since
Sep 17, 2024
Last certification
Sep 17, 2024
Beds
21
Ownership / control type
Non-profit – corporation
Facility address
7000 S.W. Varns Street
Tigard, OR 97223

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2139501Madrona Recovery7000 SW Varns, Tigard, OR 97223Certificate of waiverNov 2, 2027

National Provider Directory

National Provider Directory

Locations

7000 SW Varns St
Tigard, OR 97223
Phone 5037490200 ext. 523

Practitioners & affiliated clinicians

Practitioners 5

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": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560988800000",
    "number": "1992238091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7000 SW VARNS ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238145",
            "telephone_number": "503-749-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 SW VARNS ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238145",
            "telephone_number": "949-293-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADRONA RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2019-06-20",
        "status": "A",
        "authorized_official_last_name": "BRAITHWAITE",
        "authorized_official_first_name": "MICAH",
        "authorized_official_middle_name": "BRADY",
        "authorized_official_title_or_position": "COO/CFO",
        "authorized_official_telephone_number": "503-749-0200"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

Verify at the official NPI Registry.