JASPER MOUNTAIN NPI 1497821680

NPI Information

NPI: 1497821680
Provider Name: JASPER MOUNTAIN
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
CLIA Number: 38D2217199
Address: 37875 JASPER LOWELL RD
JASPER, OR
ZIP 97438
Phone: (541) 747-1235

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NPI Details

JASPER MOUNTAIN is a community based residential treatment facility mental illness in Jasper, OR. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. JASPER MOUNTAIN NPI is 1497821680. The provider is registered as an organization entity type.

The provider's business location address is:

37875 JASPER LOWELL RD
JASPER, OR
ZIP 97438-751
Phone: (541) 747-1235
Fax: (541) 747-4722

The provider's authorized official is Carita Chantel Lively .
The authorized official title is Compliance Specialist and has the following contact phone number (541) 747-1235.

The CLIA number assigned to this NPI record is 38D2217199 - other - long-term care facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 3/8/2024.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		OREGON	Yes
2	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children		OREGON	No
3	323P00000X	Psychiatric Residential Treatment Facility			No
4	385HR2055X	Respite Care	Respite Care, Mental Illness, Child	OREGON	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	313495	MEDICAID	OREGON
2	178087	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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