CLAIR'S II ADULT FOSTER HOME LLC (NPI# 1073150074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073150074 |
| Entity Type | Organization |
| Organization Name | CLAIR'S II ADULT FOSTER HOME LLC |
| Practice Address |
63249 Everest Rd Coos Bay OR 97420-7238 |
| Practice Telephone | 5412697955 |
| Practice Fax Number | 5412697955 |
| Mailing Telephone | 5412697955 |
| Mailing Fax Number | 5412697955 |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |
| Authorized Official Name | MR. TIMOTHY JAMES BOYSUN I (PPO) |
| Authorized Official Telephone | 5412697955 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 374U00000X | Home Health Aide | Nursing Service Related Providers | ||
| N | 376K00000X | Nurse's Aide | Nursing Service Related Providers | ||
| N | 385H00000X | Respite Care | Respite Care Facility | ||
| N | 405300000X | Prevention Professional | Other Service Providers | ||
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | STATE OF OREGON | 525988 | 01 |
| OR | 500697484 | 05 |
| Other Name | Type Code |
|---|---|
| Clair's Two Adult Foster Care | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CLAIR'S II ADULT FOSTER HOME LLC | 63249 Everest Rd, Coos Bay, OR 97420 |
| Street Address |
63249 EVEREST RD |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-7238 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801403910 | Baseti Gelgelu | Custodial Care Facility | 2055 Sw 79th Ave, Portland, OR 97225-3805 | 2020-09-23 |
| 1801402946 | Demeti Gelgelu | Custodial Care Facility | 2010 Sw 79th Ave, Portland, OR 97225-3806 | 2020-09-22 |
| 1447808100 | Remelita Loftin | Custodial Care Facility | 2297 Minnesota St, Eugene, OR 97402-6244 | 2019-08-27 |
| 1316506397 | Stephenie Jo Murdock | Custodial Care Facility | 2355 Baker St, Baker City, OR 97814-2541 | 2019-06-12 |
| 1346707296 | Dastu I Ahmat | Custodial Care Facility | 55 Nw 23rd St, Gresham, OR 97030-2640 | 2019-02-27 |
| 1558837781 | Larisa Kravchuk | Custodial Care Facility | 805 Fir Cone Dr Ne, Keizer, OR 97303-4328 | 2018-10-15 |
| 1386122687 | Diana Elizabeth Gwinn | Custodial Care Facility | 16405 Ne Fargo Cir, Portland, OR 97230-5513 | 2018-07-30 |
| 1376071464 | Mckenzie Living, Incorporated | Custodial Care Facility | 2621 Lone Oak Way, Eugene, OR 97404 | 2017-06-01 |
| 1598292997 | Gateway Assisted Living, Inc. | Custodial Care Facility | 611 N Cloverleaf Loop, Springfield, OR 97477-1188 | 2017-05-16 |
| 1841727617 | Gateway Gardens Assisted Living, Inc. | Custodial Care Facility | 178 Commons Dr, Eugene, OR 97401-8923 | 2017-05-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.