Provider Demographics
NPI:1043925852
Name:SAPPHIRE AT MYRTLE CREEK LLC
Entity Type:Organization
Organization Name:SAPPHIRE AT MYRTLE CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-887-7395
Mailing Address - Street 1:305 NE 102ND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4170
Mailing Address - Country:US
Mailing Address - Phone:503-446-2877
Mailing Address - Fax:
Practice Address - Street 1:637 ASH ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1133
Practice Address - Country:US
Practice Address - Phone:503-887-7395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility