Provider Demographics
NPI:1215488200
Name:CRC HEALTH OREGON
Entity type:Organization
Organization Name:CRC HEALTH OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CTC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FJESSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:503-252-3949
Mailing Address - Street 1:6601 NE 78TH CT STE A3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-2823
Mailing Address - Country:US
Mailing Address - Phone:503-252-3949
Mailing Address - Fax:503-252-4027
Practice Address - Street 1:6601 NE 78TH CT STE A3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2823
Practice Address - Country:US
Practice Address - Phone:503-252-3949
Practice Address - Fax:503-252-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management