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NPI Code Detail

MEDICARE: CARE CENTER (PORTHAVEN), INC.

MEDICARE: CARE CENTER (PORTHAVEN), INC.
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
1314000000XSkilled Nursing FacilityOR

General Provider Information

NPI Number : 1215923594
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARE CENTER (PORTHAVEN), INC.
Provider Business Mailing Address
First Line : 7700 NE PARKWAY DR
Second Line : SUITE 300
City : VANCOUVER
State : WA
Zip : 98662-6648
Country : US
Telephone Number : 360-735-7155
Fax Number : 360-735-9416
Provider Business Practice Location Address
First Line : 5330 NE PRESCOTT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97218-2158
Country : US
Telephone Number : 503-288-6585
Fax Number : 503-855-0014
Authorized Official
Title or Position : EXEC. VP OF FINANCE
Name : GREGORY J VISLOCKY
Credential :
Telephone Number : 360-735-7155
Provider Enumeration Date : 09/22/2005
Last Update Date : 08/22/2020

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Directions to “CARE CENTER (PORTHAVEN), INC. ” Practice Location

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