Healthcare Provider Details

I. General information

NPI: 1265473227
Provider Name (Legal Business Name): RIVERPARK, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ALEXANDER LOOP
EUGENE OR
97401-6524
US

IV. Provider business mailing address

5150 SW GRIFFITH DR
BEAVERTON OR
97005-2935
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-6199
  • Fax: 541-345-6721
Mailing address:
  • Phone: 503-646-5186
  • Fax: 503-644-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number385185
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier800941
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. BRIAN E PRYOR
Title or Position: VP OPERATIONS
Credential:
Phone: 503-646-5186