MEDICARE: FELLOWS ALF OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1023973500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FELLOWS ALF OPERATIONS LLC

Provider Business Mailing Address
First Line	:	3102 SE HOLGATE BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3416
Country	:	US
Telephone Number	:	503-231-1411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3102 SE HOLGATE BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3416
Country	:	US
Telephone Number	:	503-231-1411
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF PROCUREMENT
Name	:	JOSEPH LIEBERMAN
Credential	:
Telephone Number	:	516-855-5504

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “FELLOWS ALF OPERATIONS LLC ” Practice Location

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