Organization
ROSE CITY RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAHEEM JAHMEL WATSON PSS/CRM (OWNER/PSS)
(480) 881-4555
Entity
Organization
Contact information
Practice address
610 SE 6TH AVE, PORTLAND, OR 97214-2224
(480) 881-4555
Mailing address
610 SE 6TH AVE, PORTLAND, OR 97214-2224
(480) 881-4555
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
275N00000X
Medicare Defined Swing Bed Hospital Unit
—
—
310400000X
Assisted Living Facility
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205663739
—
OR
Enumeration date
09/23/2024
Last updated
06/04/2025
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