POWER HOUSE DETOX (NPI# 1982197182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982197182 |
| Entity Type | Organization |
| Organization Name | POWER HOUSE DETOX |
| Other Organization Name | PHD |
| Practice Address |
3955 Salmon River Hwy Otis OR 97368-9778 |
| Practice Telephone | 5417204636 |
| Practice Fax Number | 8889772106 |
| Mailing Telephone | 5417204636 |
| Mailing Fax Number | 8889772106 |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-16 |
| Authorized Official Name | MELISSA KIM HOMAN (REGIONAL DIRECTOR) |
| Authorized Official Telephone | 5417204636 |
| Authorized Official Credential | CADC II, CRM |
| Is Organization Subpart | Y |
| Parent Organization Name | THE POWER HOUSE RESIDENTIAL DRUG TREATMENT CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 276400000X | Rehabilitation, Substance Use Disorder Unit | 700119 | OR | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500667339 | 05 |
| Other Name | Type Code |
|---|---|
| PHD | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | POWER HOUSE DETOX INC. | 3955 Salmon River Hwy, Otis, OR 97368 |
| Street Address |
3955 SALMON RIVER HWY |
| City | OTIS |
| State | OR |
| Zip Code | 97368-9778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891173571 | Keva Doreen Southwell | Physician Assistant | 3955 Salmon River Hwy, Otis, OR 97368 | 2015-05-13 |
| 1609338359 | Regina Andrea Diel | Counselor | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| 1275095937 | Jamayca Jasmine Nelson | Registered Nurse | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| 1720540461 | Christine Ann Massingale | Counselor | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| 1174085831 | Nicholas James Iamon | Registered Nurse | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| 1699237354 | Curtis P Waring | Registered Nurse | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| 1437611167 | Brandie Marie Randleman | Counselor | 3955 Salmon River Hwy, Otis, OR 97368-9778 | 2019-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811459464 | Jessica Marie Homan | Counselor | 3555 Salmon River Hwy, Otis, OR 97368 | 2019-04-03 |
| 1255502340 | Sharon Ann Lee | Social Worker | 7905 Ne 50th St, Otis, OR 97368 | 2008-03-17 |
| 1992839781 | Cynthia J. Luxford | Midwife | 3013 N. Northbank Road, Otis, OR 97368 | 2007-03-15 |
| 1386947950 | Dayna Rosalie Beadel Smith | Licensed Vocational Nurse | 799 N Deerlane Loop, Otis, OR 97368-9677 | 2010-12-21 |
| 1669704052 | Home Sweet Home Birth Center, LLC | Clinic/Center | 3013 N North Bank Rd, Otis, OR 97368-9754 | 2010-02-09 |
| Taxonomy Code | 276400000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation, Substance Use Disorder Unit |
| A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.) |
| Notes: Source: Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922559764 | Kaiser Permanante | Rehabilitation, Substance Use Disorder Unit | 10180 Se Sunnyside Rd, Clackamas, OR 97015-8970 | 2016-10-17 |
| 1114030210 | Veterans Affairs | Rehabilitation, Substance Use Disorder Unit | 913 Nw Garden Valley Blvd, Ward 2, Bldg 2, Sartp, Roseburg, OR 97470-6523 | 2006-08-16 |
Please comment or provide details below to improve the information on POWER HOUSE DETOX.
| 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.