Provider Demographics
NPI:1134411531
Name:RSL PORTLAND, LLC
Entity type:Organization
Organization Name:RSL PORTLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF RADIANT COMPANIES, INC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-595-2810
Mailing Address - Street 1:4640 SW MACADAM AVE
Mailing Address - Street 2:SUITE 90
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4256
Mailing Address - Country:US
Mailing Address - Phone:503-595-2810
Mailing Address - Fax:503-595-2818
Practice Address - Street 1:3060 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3053
Practice Address - Country:US
Practice Address - Phone:503-535-4700
Practice Address - Fax:503-797-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility