Provider Demographics
NPI:1306833074
Name:CLATSOP CARE CENTER HEALTH DISTRICT
Entity Type:Organization
Organization Name:CLATSOP CARE CENTER HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-588-4428
Mailing Address - Street 1:646 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3709
Mailing Address - Country:US
Mailing Address - Phone:503-325-0313
Mailing Address - Fax:503-325-0115
Practice Address - Street 1:646 16TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3709
Practice Address - Country:US
Practice Address - Phone:503-325-0313
Practice Address - Fax:503-325-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 310400000X, 311500000X
OR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR505692Medicaid
OR526016Medicaid
OR805069Medicaid