MIRABELLA AT SOUTH WATERFRONT (NPI# 1487975959) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487975959 |
| Entity Type | Organization |
| Organization Name | MIRABELLA AT SOUTH WATERFRONT |
| Other Organization Name | MIRABELLA PORTLAND |
| Practice Address |
3550 Sw Bond Ave Portland OR 97239-4506 |
| Practice Telephone | 5036886400 |
| Mailing Telephone | 5036886400 |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2016-04-18 |
| Authorized Official Name | MRS. SHARON M MCCARTNEY (HEALTH SERVICES ADMINISTRATOR) |
| Authorized Official Telephone | 5036886400 |
| Authorized Official Credential | BS, NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 310400000X | Assisted Living Facility | 1291022896 | OR | Nursing & Custodial Care Facilities |
| N | 311500000X | Alzheimer Center (Dementia Center) | 1753514587 | OR | Nursing & Custodial Care Facilities |
| N | 313M00000X | Nursing Facility/Intermediate Care Facility | 1233196437 | OR | Nursing & Custodial Care Facilities |
| N | 311Z00000X | Custodial Care Facility | Nursing & Custodial Care Facilities | ||
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Mirabella Portland | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MIRABELLA AT SOUTH WATERFRONT | 3550 Sw Bond, Portland, OR 97239 |
| Street Address |
3550 SW BOND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97239-4506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912191909 | Shelly E Boelter | Audiologist | 3550 Sw Bond Ave, Suite 173, Portland, OR 97239-4507 | 2007-09-01 |
| 1609349398 | Calvin Yuan Wah Lee | Physical Therapist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2019-01-06 |
| 1649798745 | Travis Barden | Occupational Therapy Assistant | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2017-09-08 |
| 1174988612 | Kay Linda Foust | Occupational Therapy Assistant | 3550 Sw Bond Ave, Rehab, Portland, OR 97239 | 2015-12-29 |
| 1669840518 | Kenneth Richard Berg | Dentist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2015-09-09 |
| 1427443431 | Curtis Hartling | Audiologist | 3550 Sw Bond Ave, Suite 173, Portland, OR 97239-4507 | 2015-04-06 |
| 1265863989 | Steven Massingale | Physical Therapy Assistant | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2013-12-05 |
| 1043501836 | Geromedical Psychological Service Ps | Psychologist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2011-04-27 |
| 1497983951 | Erin M Lingo | Physical Therapist | 3550 Sw Bond Ave, Portland, OR 97239-4507 | 2009-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979468 | Elise Caitlin Esposito | Student in an Organized Health Care Education/Training Program | 3710 Sw U.S. Veterans Hospital Road, Dental Service P-3 Dent, Attn: Elise Esposito, Portland, OR 97239 | 2020-07-16 |
| 1750908844 | Will Cowan | Student in an Organized Health Care Education/Training Program | 455 Sw Us Veterans Hospital Road., Portland, OR 97239 | 2020-07-06 |
| 1881219657 | Desiree Baer | Licensed Vocational Nurse | Sw Us Veterans Hospital Rd, Portland, OR 97239 | 2020-06-08 |
| 1285266205 | Melissa Irene Wheeler | Registered Nurse | Uhs-8l, 3181 S.w. Sam Jackson Park Road, Portland, OR 97239 | 2020-02-07 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1801448063 | Alice Huang Huang | Student in an Organized Health Care Education/Training Program | 3710 Sw Veterans Road, Portland, OR 97239 | 2019-07-09 |
| 1710446273 | Ellen Noreen Kessi | Social Worker | 3710 Sw Us Veterans Rd., Portland, OR 97239 | 2019-03-14 |
| 1508335704 | Jacqueline Marie Mular | Marriage & Family Therapist | 5550 Sw Macadam Suite 100, Portland, OR 97239 | 2018-11-16 |
| 1275030926 | Carly Elizabeth Dougher | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd., Portland, OR 97239 | 2018-04-10 |
| 1780188094 | Dennis John Samuel | Student in an Organized Health Care Education/Training Program | Ohsu, 3181 Sw Sam Jackson Park Rd. L-579, Portland, OR 97239 | 2018-03-21 |
| Find all providers in zip 97239 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861835456 | Marquis Companies II, Inc. | Skilled Nursing Facility | 319 Ne Russet St, Portland, OR 97211-2815 | 2013-04-12 |
| 1942437298 | Anita August | Skilled Nursing Facility | 300 Nw 8th Ave Apt 707, Portland, OR 97209-3560 | 2009-06-14 |
| 1720151988 | Care Center East Health - Portland, LLC | Skilled Nursing Facility | 11325 Ne Weidler St, Portland, OR 97220-1950 | 2006-11-16 |
| 1659470193 | Eagle Healthcare, Inc | Skilled Nursing Facility | 745 Ne 122nd Ave, Portland, OR 97230-2001 | 2006-09-21 |
| 1932211968 | Marquis Companies I, Inc | Skilled Nursing Facility | 725 Se 202nd Ave, Portland, OR 97233-6105 | 2006-08-31 |
| 1508978537 | Marquis Companies I, Inc | Skilled Nursing Facility | 1475 Se 100th Ave, Portland, OR 97216-2537 | 2006-08-31 |
| 1942312905 | Marquis Companies I, Inc | Skilled Nursing Facility | 6010 Sw Shattuck Rd, Portland, OR 97221-1043 | 2006-08-31 |
| 1205841095 | Adventist Health System Texas, Inc. | Skilled Nursing Facility | 215 Highland Circle Dr, Portland, TN 37148-4918 | 2006-07-30 |
| 1629008651 | Harbor Care Corporation | Skilled Nursing Facility | 3540 Se Francis St, Portland, OR 97202-3350 | 2006-07-04 |
| 1114969912 | West Hills Convalescent Center Limited Partnership | Skilled Nursing Facility | 5701 Sw Multnomah Blvd, Portland, OR 97219-3195 | 2006-06-13 |
| 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.