# MADRONA RECOVERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992238091
- **Authorized official:** MICAH BRADY BRAITHWAITE (COO/CFO)
- **Authorized official phone:** (503) 749-0200

## Contact information

- **Practice address:** 7000 SW VARNS ST, TIGARD, OR 97223-8145
- **Practice address phone:** (949) 293-2351
- **Mailing address:** 7000 SW VARNS ST, TIGARD, OR 97223-8145
- **Mailing address phone:** (503) 749-0200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | — | NULL | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | — | OR | — |

## Other

- **Enumeration date:** 04/05/2017
- **Last updated:** 06/20/2019