SOBER LIVING OREGON RECOVERY CENTER (NPI# 1073081881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073081881 |
| Entity Type | Organization |
| Organization Name | SOBER LIVING OREGON RECOVERY CENTER |
| Practice Address |
1122 Ne 122nd Ave Ste A102 Portland OR 97230-2082 |
| Mailing Address |
9979 Se Old Town Ct Happy Valley OR 97086-2382 |
| Practice Telephone | 5039541890 |
| Mailing Telephone | 5033324969 |
| Mailing Fax Number | 9718884607 |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2018-11-09 |
| Authorized Official Name | TODD FLYNN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5033324969 |
| Authorized Official Credential | MA, CADC II |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SOBER LIVING OREGON RECOVERY CENTER | 1122 Ne 122nd Ave Ste A-102, Portland, OR 97230 |
| Oregon Corporations, Companies and Business Names | SOBER LIVING OREGON RECOVERY CENTER, LLC | 1122 Ne 122nd Ave Ste A200, Portland, OR 97230 |
| Street Address |
1122 NE 122ND AVE STE A102 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230-2082 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386275808 | Ian Stuart Murphy | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2020-02-03 |
| 1124668447 | Laurie Fortin | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2020-01-14 |
| 1881235406 | Julia Rose Eggen | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2019-10-04 |
| 1073154605 | Kazia Sing Romain Berman | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2019-10-04 |
| 1639637325 | Laura Faye Dunn | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2019-03-12 |
| 1912462417 | Summer Baker | Counselor | 1122 Ne 122nd Ave Ste A102, Portland, OR 97230-2082 | 2019-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710586821 | Plum Consulting LLC | Community/Behavioral Health | 1161 Nw Overton St Apt 1501, Portland, OR 97209-2549 | 2020-10-20 |
| 1790302677 | Hope for All Community Services LLC | Community/Behavioral Health | 68 Bishop St, Building 1, Unit 1, Portland, ME 04103 | 2020-06-26 |
| 1184247850 | Altoris Behavior Support LLC | Community/Behavioral Health | 3880 Se 8th Ave Ste 105, Portland, OR 97202-3772 | 2020-05-28 |
| 1619599636 | Rivers Way Training Clinic | Community/Behavioral Health | 2049 Nw Hoyt, Portland, OR 97209 | 2020-05-13 |
| 1578102216 | Act Nw | Community/Behavioral Health | 909 Nw 24th Ave, Portland, OR 97210-3009 | 2019-12-28 |
| 1194284349 | Oriel Offit, Clinical Psychologist, LLC | Community/Behavioral Health | 222 Saint John St Ste 227, Portland, ME 04102-3058 | 2019-03-18 |
| 1396210977 | Ask Counseling LLC | Community/Behavioral Health | 8885 Sw Canyon Rd Ste 108, Portland, OR 97225-3431 | 2018-10-10 |
| 1790260313 | Bernard J. Gordon Md Pa LLC | Community/Behavioral Health | 145 Newbury St Fl 1, Portland, ME 04101-4261 | 2018-09-28 |
| 1497235576 | Saturn Supports LLC | Community/Behavioral Health | 3228 Sw Beaverton Hillsdale Hwy Apt 23, Portland, OR 97239-1193 | 2018-08-17 |
| 1770063067 | Nami Multnomah | Community/Behavioral Health | 524 Ne 52nd Ave, Portland, OR 97213-3047 | 2018-08-16 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on SOBER LIVING OREGON RECOVERY CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.