MEDICARE: FORT VANCOUVER ALF OPERATIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	227900000X	Registered Respiratory Therapist
4	235Z00000X	Speech-Language Pathologist
5	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1609606458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT VANCOUVER ALF OPERATIONS, LLC

Provider Business Mailing Address
First Line	:	4601 NE 77TH AVE STE 300
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6736
Country	:	US
Telephone Number	:	360-837-0400
Fax Number	:	360-967-0022

Provider Business Practice Location Address
First Line	:	8422 NE 8TH WAY
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1974
Country	:	US
Telephone Number	:	360-256-2980
Fax Number	:	360-256-1909

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	YITZCHOK YENOWITZ
Credential	:
Telephone Number	:	732-769-8877

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	09/05/2024

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Directions to “FORT VANCOUVER ALF OPERATIONS, LLC ” Practice Location

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