Provider Demographics
NPI:1720151988
Name:CARE CENTER EAST HEALTH - PORTLAND, LLC
Entity Type:Organization
Organization Name:CARE CENTER EAST HEALTH - PORTLAND, LLC
Other - Org Name:CARE CENTER EAST HEALTH & SPECIALTY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-678-4426
Mailing Address - Street 1:11325 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-1950
Mailing Address - Country:US
Mailing Address - Phone:503-253-1181
Mailing Address - Fax:503-253-1871
Practice Address - Street 1:11325 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1950
Practice Address - Country:US
Practice Address - Phone:503-253-1181
Practice Address - Fax:503-253-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR809665Medicaid
OR385219Medicare Oscar/Certification