Provider Demographics
NPI:1023313491
Name:GRACELEN TERRACE MANAGING COMPANY
Entity type:Organization
Organization Name:GRACELEN TERRACE MANAGING COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:503-760-1727
Mailing Address - Street 1:10948 SE BOISE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2202
Mailing Address - Country:US
Mailing Address - Phone:503-760-1727
Mailing Address - Fax:503-762-2331
Practice Address - Street 1:6003 SE 136TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4567
Practice Address - Country:US
Practice Address - Phone:503-761-1155
Practice Address - Fax:503-761-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1600506066313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility