Provider Demographics
NPI:1164256889
Name:ATLAS RECOVERY LLC
Entity type:Organization
Organization Name:ATLAS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-228-0864
Mailing Address - Street 1:15230 NW PERIMETER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5410
Mailing Address - Country:US
Mailing Address - Phone:541-228-0864
Mailing Address - Fax:
Practice Address - Street 1:411 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4801
Practice Address - Country:US
Practice Address - Phone:541-228-0864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder