Healthcare Provider Details

I. General information

NPI: 1265352173
Provider Name (Legal Business Name): PORTLAND WEST OF CASCADIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 SW 30TH AVE
PORTLAND OR
97239-1007
US

IV. Provider business mailing address

6530 SW 30TH AVE
PORTLAND OR
97239-1007
US

V. Phone/Fax

Practice location:
  • Phone: 503-244-7533
  • Fax:
Mailing address:
  • Phone: 208-401-9600
  • 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: OWEN HAMMOND
Title or Position: PRESIDENT
Credential:
Phone: 208-401-9600