Provider Demographics
NPI:1043788896
Name:RECLAIM LIFE, LLC
Entity Type:Organization
Organization Name:RECLAIM LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-286-3209
Mailing Address - Street 1:425 2ND AVE SW STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2483
Mailing Address - Country:US
Mailing Address - Phone:541-286-3209
Mailing Address - Fax:541-704-0040
Practice Address - Street 1:425 2ND AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2483
Practice Address - Country:US
Practice Address - Phone:541-286-3209
Practice Address - Fax:541-704-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500763687Medicaid