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NPI Code Detail

MEDICARE: MARYVILLE NURSING HOME

MEDICARE: MARYVILLE NURSING HOME
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
2313M00000XNursing Facility/Intermediate Care FacilityOR
3311500000XAlzheimer Center (Dementia Center)OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285631036
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARYVILLE NURSING HOME
Provider Business Mailing Address
First Line : 14645 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-2727
Country : US
Telephone Number : 503-643-8626
Fax Number : 503-520-1435
Provider Business Practice Location Address
First Line : 14645 SW FARMINGTON RD
Second Line :
City : BEAVERTON
State : OR
Zip : 97007-2727
Country : US
Telephone Number : 503-643-8626
Fax Number : 503-520-1435
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. KATHLEEN PARRY
Credential :
Telephone Number : 503-643-8626
Provider Enumeration Date : 07/07/2005
Last Update Date : 09/11/2025

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1841621851 — GURPREET SINGH COTA/L
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Directions to “MARYVILLE NURSING HOME ” Practice Location

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