MEDICARE: SH1 CEDAR CREST OPCO 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	311500000X	Alzheimer Center (Dementia Center)
2	310400000X	Assisted Living Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1558167841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH1 CEDAR CREST OPCO LLC

Provider Business Mailing Address
First Line	:	5101 NE 82ND AVE STE 200
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6343
Country	:	US
Telephone Number	:	360-254-9442
Fax Number	:

Provider Business Practice Location Address
First Line	:	18325 SW PACIFIC HWY
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-6966
Country	:	US
Telephone Number	:	503-925-0544
Fax Number	:	503-625-2301

Authorized Official
Title or Position	:	LICENSING COORDINATOR
Name	:	TERRI BAKER
Credential	:
Telephone Number	:	564-203-3620

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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Directions to “SH1 CEDAR CREST OPCO LLC ” Practice Location

Language	Start Address	Practice Location

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