Provider Demographics
NPI:1629958921
Name:OREGON RECOVERY ALLIANCE LLC
Entity type:Organization
Organization Name:OREGON RECOVERY ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:PORTE
Authorized Official - Suffix:
Authorized Official - Credentials:CRM
Authorized Official - Phone:503-990-4821
Mailing Address - Street 1:2412 SE 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3059
Mailing Address - Country:US
Mailing Address - Phone:503-990-4821
Mailing Address - Fax:
Practice Address - Street 1:2412 SE 106TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3059
Practice Address - Country:US
Practice Address - Phone:503-990-4821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR245190194OtherOREGONBUSINESSREGISTRY