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General NPI Number Information
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NPI Number | 1205709243
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Entity Type | Organization
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Legal Business Name | BEAVERTON OF CASCADIA, LLC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 11850 SW ALLEN BLVD
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City | BEAVERTON
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State | OR
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Zip | 97005-4805
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Country | US
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Telephone | 503-646-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 E RIVERSIDE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-7621
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Country | US
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Telephone | 208-401-9600
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | OWEN C HAMMOND
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Credential |
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Telephone | 208-401-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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