Healthcare Provider Details

I. General information

NPI: 1033740899
Provider Name (Legal Business Name): SAPPHIRE AT GRESHAM REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NE 5TH ST
GRESHAM OR
97030-7345
US

IV. Provider business mailing address

305 NE 102ND AVE STE 250
PORTLAND OR
97220-4170
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5600
  • Fax: 503-907-8911
Mailing address:
  • Phone: 503-446-2877
  • Fax: 971-230-5846

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: KEVIN MICHAEL RICKER
Title or Position: MANAGING MEMBER
Credential:
Phone: 503-887-7395