Healthcare Provider Details

I. General information

NPI: 1780670182
Provider Name (Legal Business Name): PCI CARE VENTURE I INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PACIFIC AVE
FOREST GROVE OR
97116-2226
US

IV. Provider business mailing address

7700 NE PARKWAY DR SUITE 300
VANCOUVER WA
98662-6648
US

V. Phone/Fax

Practice location:
  • Phone: 503-359-0449
  • Fax: 503-357-8086
Mailing address:
  • Phone: 360-735-7155
  • Fax: 360-735-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY J VISLOCKY
Title or Position: EXEC. VP OF FINANCE
Credential:
Phone: 360-735-7155