38D2182402 CLIA NUMBER - PACIFIC CREST TRAIL DETOX

Laboratory Demographics

  • CLIA Code: 38D2182402
  • Facility Name: PACIFIC CREST TRAIL DETOX
  • Facility Address: 14180 SE UPPER ALDERCREST DRIVE
    PORTLAND, OR
    ZIP 97267
  • Facility Phone: 855 770-0577
  • Facility Type: Other - SUBSTANCE USE DISORDER
  • Facility Type: Waiver
  • Lab Director: BENJAMIN D. RANDOLPH
  • NPI Number: 1043760838
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 38D2182402
LAB Type Other - SUBSTANCE USE DISORDER
Facility Name PACIFIC CREST TRAIL DETOX
Street 14180 SE UPPER ALDERCREST DRIVE
City PORTLAND
State OR
ZIP 97267
Phone 855 770-0577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2024
Certificate Expiration Date 4/20/2026
Facility Type Other - SUBSTANCE USE DISORDER
Lab Director BENJAMIN D. RANDOLPH

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