Organization
CHRONICLES OF SUCCESS RECOVERY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONIQUE BOAZEMAN (OWNER/ADMINISTRATOR)
(313) 977-2767
Entity
Organization
Contact information
Practice address
3140 JUANIPERO WAY STE 101, MEDFORD, OR 97504-8647
(541) 508-0336
(541) 508-0330
Mailing address
5441 S MACADAM AVE STE N, PORTLAND, OR 97239-6106
(866) 674-3347
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
08/26/2024
Last updated
06/03/2025
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