Provider Demographics
NPI:1205204609
Name:CARE CENTER (MILWAUKIE) INC.
Entity Type:Organization
Organization Name:CARE CENTER (MILWAUKIE) INC.
Other - Org Name:PRESTIGE POST-ACUTE AND REHABILITATION CENTER - MILWAUKIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EX VP OF FINANCE / PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VISLOCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-7155
Mailing Address - Street 1:12045 SE STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2938
Mailing Address - Country:US
Mailing Address - Phone:503-659-2323
Mailing Address - Fax:
Practice Address - Street 1:12045 SE STANLEY AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2938
Practice Address - Country:US
Practice Address - Phone:503-659-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-02
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500695377Medicaid
OR500695377Medicaid