Healthcare Provider Details

I. General information

NPI: 1659656437
Provider Name (Legal Business Name): CARE CENTER REEDWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 SE FRANCIS ST
PORTLAND OR
97202-3350
US

IV. Provider business mailing address

7700 NE PARKWAY DR STE 300
VANCOUVER WA
98662-6648
US

V. Phone/Fax

Practice location:
  • Phone: 503-232-5767
  • Fax: 503-234-4162
Mailing address:
  • Phone: 360-735-7155
  • Fax: 360-735-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier800091
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. GREGORY J VISLOCKY
Title or Position: EX VP OF FINANCE/PARTNER
Credential:
Phone: 360-735-7155