Provider Demographics
NPI:1073720017
Name:CHAISE GROUP, LLC
Entity type:Organization
Organization Name:CHAISE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRUMMENACKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC-III
Authorized Official - Phone:503-740-1971
Mailing Address - Street 1:10117 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE F1217
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-7708
Mailing Address - Country:US
Mailing Address - Phone:503-740-1971
Mailing Address - Fax:503-771-2436
Practice Address - Street 1:9123 SE SAINT HELENS ST STE 100F
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6800
Practice Address - Country:US
Practice Address - Phone:503-740-1971
Practice Address - Fax:503-771-2436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906704OtherPTAN
ORR145204OtherPTAN
ORP94143Medicare UPIN