Organization
OREGON TRAIL RECOVERY LLC
Active
Organization
OREGON TRAIL RECOVERY LLC
Active
Other names
Clean Adventures of Oregon
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN RANDOLPH (OWNER)
(503) 901-1836
Entity
Organization
Contact information
Practice address
10600 SE MCLOUGHLIN BLVD, STE 207, MILWAUKIE, OR 97222-7428
(503) 901-1836
Mailing address
10600 SE MCLOUGHLIN BLVD, STE 207, MILWAUKIE, OR 97222-7428
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
03/06/2014
Last updated
04/28/2015
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