Provider Demographics
NPI:1700319381
Name:PORTLAND OF CASCADIA LLC
Entity Type:Organization
Organization Name:PORTLAND OF CASCADIA LLC
Other - Org Name:SECORA REHABILITATION OF CASCADIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-9600
Mailing Address - Street 1:2205 E RIVERSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7621
Mailing Address - Country:US
Mailing Address - Phone:208-401-9600
Mailing Address - Fax:
Practice Address - Street 1:10435 SE CORA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2331
Practice Address - Country:US
Practice Address - Phone:503-760-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADIA OREGON OPERATIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-10
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility