Provider Demographics
NPI:1659483634
Name:MARQUIS COMPANIES I, INC
Entity Type:Organization
Organization Name:MARQUIS COMPANIES I, INC
Other - Org Name:MARQUIS CARE AT WILSONVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-206-5200
Mailing Address - Street 1:30900 SW PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7835
Mailing Address - Country:US
Mailing Address - Phone:503-682-2840
Mailing Address - Fax:503-682-2869
Practice Address - Street 1:30900 SW PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7835
Practice Address - Country:US
Practice Address - Phone:503-682-2840
Practice Address - Fax:503-682-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR512409Medicaid
OR800058Medicaid
OR512409Medicaid
OR385266Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER