38D2068300 CLIA NUMBER - OREGON TRAIL RECOVERY LLC

Laboratory Demographics

  • CLIA Code: 38D2068300
  • Facility Name: OREGON TRAIL RECOVERY LLC
  • Facility Address: 10600 SE MCLOUGHLIN BLVD #207
    MILWAUKIE, OR
    ZIP 97222
  • Facility Phone: 503 901-1836
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: BENJAMIN D RANDOLPH
  • NPI Number: 1194175067
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 38D2068300
LAB Type Independent
Facility Name OREGON TRAIL RECOVERY LLC
Street 10600 SE MCLOUGHLIN BLVD #207
City MILWAUKIE
State OR
ZIP 97222
Phone 503 901-1836
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Independent
Lab Director BENJAMIN D RANDOLPH

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This page was last updated on: 9/29/2025