Organization
RECLAIM CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE S NICOSIA (OWNER)
(503) 406-1009
Entity
Organization
Contact information
Practice address
446 VILLA RD, NEWBERG, OR 97132-1856
(503) 406-1009
Mailing address
470 N VILLA RD, NEWBERG, OR 97132-1858
(503) 406-1009
(503) 200-2975
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/05/2019
Last updated
03/06/2020
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