Healthcare Provider Details

I. General information

NPI: 1790925428
Provider Name (Legal Business Name): OHANA HARMONY HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NE 27TH ST
BEND OR
97701-9548
US

IV. Provider business mailing address

25117 SW PARKWAY AVE SUITE F
WILSONVILLE OR
97070-9697
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-0479
  • Fax: 541-389-7054
Mailing address:
  • Phone: 503-570-3405
  • Fax: 503-570-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: K. RICKARD MILLER JR.
Title or Position: OWNER
Credential:
Phone: 503-570-3405