Healthcare Provider Details

I. General information

NPI: 1346956406
Provider Name (Legal Business Name): SAPPHIRE AT MYRTLE POINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 ASH ST
MYRTLE POINT OR
97458-1133
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 541-572-2066
  • Fax: 541-572-5477
Mailing address:
  • Phone: 503-254-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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