PACIFIC CREST TRAIL DETOX LLC NPI 1043760838

NPI Information

PACIFIC CREST TRAIL DETOX LLC is a substance abuse rehabilitation facility in Milwaukie, OR. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. PACIFIC CREST TRAIL DETOX LLC NPI is 1043760838. The provider is registered as an organization entity type.

The provider's business location address is:

7708 SE CLACKAMAS RD
MILWAUKIE, OR
ZIP 97267-405
Phone: (503) 908-8875

The provider's authorized official is Benjamin Randolph .
The authorized official title is Ceo and has the following contact phone number (503) 901-1836.

The enumeration date for this NPI number is 10/5/2016 and was last updated on 10/5/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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