Provider Demographics
NPI:1821024977
Name:GEISTLINGER ENTERPRISES INC
Entity Type:Organization
Organization Name:GEISTLINGER ENTERPRISES INC
Other - Org Name:ROSE CITY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC TRES
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISTLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-231-0276
Mailing Address - Street 1:PO BOX 1980
Mailing Address - Street 2:
Mailing Address - City:GRISHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030
Mailing Address - Country:US
Mailing Address - Phone:503-231-0276
Mailing Address - Fax:503-238-8678
Practice Address - Street 1:34 NE 20TH
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-231-0276
Practice Address - Fax:503-238-8678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR115456310500000X
OR1137257158310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38E157OtherFEDERAL PROVIDER NUMBER
OR800060Medicaid