Healthcare Provider Details

I. General information

NPI: 1558167841
Provider Name (Legal Business Name): SH1 CEDAR CREST OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18325 SW PACIFIC HWY
TUALATIN OR
97062-6966
US

IV. Provider business mailing address

5101 NE 82ND AVE STE 200
VANCOUVER WA
98662-6343
US

V. Phone/Fax

Practice location:
  • Phone: 503-925-0544
  • Fax: 503-625-2301
Mailing address:
  • Phone: 360-254-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRI BAKER
Title or Position: LICENSING COORDINATOR
Credential:
Phone: 564-203-3620