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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