MEDICARE: FERNHILL ESTATES, 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	313M00000X	Nursing Facility/Intermediate Care Facility	385237	OR

General Provider Information

NPI Number	:	1811987779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNHILL ESTATES, LLC

Provider Business Mailing Address
First Line	:	5737 NE 37TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 NE 37TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7905
Country	:	US
Telephone Number	:	503-288-5967
Fax Number	:

Authorized Official
Title or Position	:	NURSING HOME ADMINISTRATOR
Name	:	CHERYL LYNNE EMERSON
Credential	:
Telephone Number	:	503-288-5967

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	08/22/2020

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