| Premiere Recovery Center Llc | |
|
14935 Se 82nd Dr Clackamas OR 97015-9624 | |
| (503) 332-4969 | |
| Not Available |
| Full Name | Premiere Recovery Center Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 14935 Se 82nd Dr, Clackamas, Oregon |
| Authorized Official Name and Position | Gerald Todd Flynn (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5033324969 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premiere Recovery Center Llc 2080 Nw 160th Ave Beaverton OR 97006-7640 Ph: (503) 332-4969 | Premiere Recovery Center Llc 14935 Se 82nd Dr Clackamas OR 97015-9624 Ph: (503) 332-4969 |
| NPI Number | 1942981493 |
|---|---|
| Provider Enumeration Date | 07/27/2023 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942981493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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