Provider Demographics
NPI:1538701495
Name:GENSANDIMAS LLC
Entity Type:Organization
Organization Name:GENSANDIMAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-594-2263
Mailing Address - Street 1:8440 SE SUNNYBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5781
Mailing Address - Country:US
Mailing Address - Phone:503-652-0750
Mailing Address - Fax:
Practice Address - Street 1:1740 S SAN DIMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-5108
Practice Address - Country:US
Practice Address - Phone:503-652-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility