Healthcare Provider Details

I. General information

NPI: 1881611812
Provider Name (Legal Business Name): CLACKAMAS REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E HEREFORD ST
GLADSTONE OR
97027-2165
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 503-656-0393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MANAGER
Credential:
Phone: 503-570-3405