RUSSELLVILLE III LLC (NPI# 1164845921) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164845921 |
| Entity Type | Organization |
| Organization Name | RUSSELLVILLE III LLC |
| Other Organization Name | RUSSELLVILLE PARK |
| Practice Address |
23 Se 103rd Ave Portland OR 97216 |
| Practice Telephone | 5032545900 |
| Mailing Telephone | 5032545900 |
| Mailing Fax Number | 5032557098 |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2014-01-30 |
| Authorized Official Name | MR. RAYN RASAR (VP OPERATIONS) |
| Authorized Official Telephone | 2064367827 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Russellville Park | Doing Business As Name - Organization |
| Street Address |
23 SE 103RD AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306291497 | Claire Marie Skurka Mysliwy | Physical Therapist | 23 Se 103rd Ave, Portland, OR 97216-2790 | 2016-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384576 | Pacifica Calaroga Terrace LLC | Assisted Living Facility | 1400 Ne 2nd Ave, Portland, OR 97232-1148 | 2020-10-22 |
| 1366068959 | Harvest Homes Inc | Assisted Living Facility | 6921 N Roberts Ave, Portland, OR 97203-6385 | 2020-06-19 |
| 1700408010 | Senior Haven LLC | Assisted Living Facility | 12140 Se Foster Rd, Portland, OR 97266-4043 | 2020-05-08 |
| 1508407016 | Blandina Chitalah | Assisted Living Facility | 342 Woodford St Unit 1, Portland, ME 04103-5608 | 2019-10-05 |
| 1962058024 | Bright Lantern Home Care | Assisted Living Facility | 14 Powsland St Apt 2, Portland, ME 04102-2622 | 2019-08-14 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1215368840 | The Meadows At Halltown, Inc. | Assisted Living Facility | 711 Halltown Rd, Portland, TN 37148-9071 | 2013-12-08 |
| 1811219397 | Richland Place Senior Living | Assisted Living Facility | 201 Richland Lake Dr, Portland, TN 37148-1775 | 2010-02-24 |
| 1477881951 | Fallbrook Residential Care Facility, Inc. | Assisted Living Facility | 418 Ray St, Portland, ME 04103-3934 | 2009-11-23 |
| 1538387147 | Carriage Inn Limited Partnership | Assisted Living Facility | 401 Northshore Blvd, Portland, TX 78374-3800 | 2007-04-22 |
| Find all providers in PORTLAND | ||||
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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.