SENIOR HAVEN LLC (NPI# 1700408010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700408010 |
| Entity Type | Organization |
| Organization Name | SENIOR HAVEN LLC |
| Practice Address |
12140 Se Foster Rd Portland OR 97266-4043 |
| Mailing Address |
Po Box 1410 Bend OR 97709-1410 |
| Practice Telephone | 9712718975 |
| Mailing Telephone | 5413179188 |
| Mailing Fax Number | 5413893710 |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-08 |
| Authorized Official Name | ROBERT AUSTIN EVANS (MANAGING MEMBER) |
| Authorized Official Telephone | 5413179188 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 164402 | 05 |
| Other Name | Type Code |
|---|---|
| Senior Haven RCF | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | SENIOR HAVEN LLC | 12140 Se Foster Road, Portland, OR 97266 |
| Street Address |
12140 SE FOSTER RD |
| City | PORTLAND |
| State | OR |
| Zip Code | 97266-4043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528545969 | Willamette Pharmacy | Pharmacy | 10209 Se Division Build B Ste 100, Portland, OR 97266 | 2018-07-27 |
| 1992204697 | Sober Living Oregon Treatment Center | Clinic/Center | 10209 Se Division, Portland, OR 97266 | 2018-02-08 |
| 1699204024 | Malori Christine Butler | Registered Nurse | 7335 Se 85th Ave., Portland, OR 97266 | 2017-06-08 |
| 1487028882 | Emil Kunkel | Naturopath | 6318 Se 87th Ave, Portland, OR 97266 | 2015-11-23 |
| 1194195313 | Cory Hall-martin | Counselor | 10011 Se Division St #305, Portland, OR 97266 | 2015-09-30 |
| 1336517721 | Krispin Mayfield | Counselor | 10011 Se Division St., Suite 203, Portland, OR 97266 | 2015-09-02 |
| 1407247927 | Syrena Nicholson | Community Health Worker | 7721 Se 92nd Avenue, Apt K, Portland, OR 97266 | 2015-02-06 |
| 1659777886 | Berhanu Aynalem Mekbib | Adult Companion | 9125 Sw 55th, El Dorado, Portland, OR 97266 | 2014-11-17 |
| 1871930685 | Felicitas Amelia Penaloza | Behavioral Analyst | 9911 Se Mt.scott Boulevard, Portland, OR 97266 | 2013-06-03 |
| 1710237326 | Janna Renee Higgins | Case Manager/Care Coordinator | 9911 Se Mt. Scott Boulevard, Portland, OR 97266 | 2012-09-12 |
| Find all providers in zip 97266 | ||||
| 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 |
| 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 |
| 1164845921 | Russellville IIi LLC | Assisted Living Facility | 23 Se 103rd Ave, Portland, OR 97216 | 2014-01-30 |
| 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.