MEDICARE: MONTEREY MC CARE PROPERTIES, 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

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	:	1588280275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEREY MC CARE PROPERTIES, LLC

Provider Business Mailing Address
First Line	:	7420 SW BRIDGEPORT RD STE 105
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-7790
Country	:	US
Telephone Number	:	503-597-4906
Fax Number	:

Provider Business Practice Location Address
First Line	:	8915 SE MONTEREY AVE
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-7509
Country	:	US
Telephone Number	:	503-654-3230
Fax Number	:	503-654-3800

Authorized Official
Title or Position	:	MEMBER
Name	:	GREGORY RODERICK
Credential	:
Telephone Number	:	503-443-1818

Provider Enumeration Date	:	06/18/2020
Last Update Date	:	06/18/2020

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