Provider Demographics
NPI:1679819411
Name:ROSE VILLA, INC.
Entity Type:Organization
Organization Name:ROSE VILLA, INC.
Other - Org Name:ROSE VILLA SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:503-652-3282
Mailing Address - Street 1:13505 SE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-8038
Mailing Address - Country:US
Mailing Address - Phone:503-654-3171
Mailing Address - Fax:
Practice Address - Street 1:13505 SE RIVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-8038
Practice Address - Country:US
Practice Address - Phone:503-654-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1352498888313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility