NPI 1043760838
Pacific Crest Trail Detox LLC
Practice location
- Address
- 7708 SE Clackamas Rd, Milwaukie, OR 97267-4405
- Phone
- (503) 908-8875
- Mailing address
- 10600 SE McLoughlin Blvd 207, Milwaukie, OR 97222-7428
Authorised official
- Name
- Benjamin Randolph
- Title
- Ceo
- Phone
- (503) 901-1836
Registered specialties
Substance Abuse Rehabilitation Facility
Primary
Registry record
- NPI
- 1043760838
- Entity type
- Organization
- NPI issued
- 5 Oct 2016
- Record last updated
- 5 Oct 2016
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.