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NPI Code Detail

MEDICARE: LAURELHURST VILLAGE LLC

MEDICARE: LAURELHURST VILLAGE 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
1310400000XAssisted Living FacilityOR
2313M00000XNursing Facility/Intermediate Care FacilityOR
3314000000XSkilled Nursing FacilityOR

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 : 1346288362
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAURELHURST VILLAGE LLC
Provider Business Mailing Address
First Line : 3060 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-3053
Country : US
Telephone Number : 503-535-4700
Fax Number : 503-797-6702
Provider Business Practice Location Address
First Line : 3060 SE STARK ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-3053
Country : US
Telephone Number : 503-535-4700
Fax Number : 503-797-6702
Authorized Official
Title or Position : CEO
Name : MS. TERESA LEE WALOROFF
Credential : RN MS
Telephone Number : 503-595-2810
Provider Enumeration Date : 06/03/2006
Last Update Date : 09/11/2025

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Directions to “LAURELHURST VILLAGE LLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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