Provider Demographics
NPI:1265074181
Name:GENDENVER LLC
Entity type:Organization
Organization Name:GENDENVER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-594-2263
Mailing Address - Street 1:8440 SE SUNNYBROOK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5781
Mailing Address - Country:US
Mailing Address - Phone:503-652-0750
Mailing Address - Fax:
Practice Address - Street 1:2500 S ROSLYN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3745
Practice Address - Country:US
Practice Address - Phone:503-652-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility