Healthcare Provider Details

I. General information

NPI: 1396576617
Provider Name (Legal Business Name): VILLAGE SNF OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 SE 182ND AVE
GRESHAM OR
97030-5036
US

IV. Provider business mailing address

4601 NE 77TH AVE STE 300
VANCOUVER WA
98662-6736
US

V. Phone/Fax

Practice location:
  • Phone: 360-837-0400
  • Fax: 360-967-0022
Mailing address:
  • Phone: 360-837-0400
  • Fax: 360-967-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: YITZCHOK YENOWITZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-769-8877