OrganizationActive
Chronicles of Success Recovery Services LLC
NPI 1629801543 · Mental Health Clinic/Center (Including Community Mental Health Center) · Medford, OR
Provider details
- NPI number
- 1629801543
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Donique Boazeman, Owner/Administrator(313) 977-2767
Specialties & taxonomies
Ambulatory Health Care Facilities
- Case Management Agency251B00000X
Agencies
- Community/Behavioral Health Agency251S00000X
Agencies
- Meals Provider174200000X
Other Service Providers
- Lodging Provider177F00000X
Other Service Providers
Ambulatory Health Care Facilities
Practice location
3140 Juanipero Way Ste 101
Medford, OR 97504-8647
Phone: (541) 508-0336
Fax: (541) 508-0330
Approximate (ZIP-level) locationGet directions
Mailing address
5441 S Macadam Ave Ste N
Portland, OR 97239-6106
Registry dates
- Enumerated
- 2024-08-26
- Last updated
- 2025-06-03
- Certified
- 2025-06-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.