Healthcare Provider Details

I. General information

NPI: 1033898325
Provider Name (Legal Business Name): OHANA GARDEN CITY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 NE KELLY AVE
GRESHAM OR
97030-5638
US

IV. Provider business mailing address

352 NW 2ND AVE
CANBY OR
97013-3626
US

V. Phone/Fax

Practice location:
  • Phone: 503-789-5345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HILTY
Title or Position: PRESIDENT
Credential:
Phone: 150-378-9534