Provider Demographics
NPI:1619592193
Name:CONCEPTS IN COMMUNITY LIVING, INC.
Entity Type:Organization
Organization Name:CONCEPTS IN COMMUNITY LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-327-5700
Mailing Address - Street 1:15900 SE 82ND DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9502
Mailing Address - Country:US
Mailing Address - Phone:503-255-4647
Mailing Address - Fax:
Practice Address - Street 1:1337 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2328
Practice Address - Country:US
Practice Address - Phone:503-223-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances