FM Ocean Ridge, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FM OCEAN RIDGE, LLC

Practice address

1855 Ocean Blvd SE
Coos Bay, OR 97420-1940

Phone

(541) 267-4000

Fax

(541) 267-4411

NPI assigned

Jun 19, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ocean Ridge Assisted Living Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1053937680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-597-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 OCEAN BLVD SE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201940",
            "telephone_number": "541-267-4000",
            "fax_number": "541-267-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FM OCEAN RIDGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-443-1818"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524685",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ocean Ridge Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie Lynn Fisher
• Treavor Fisher, D.D.S.
• Brandy Flood, MASSAGE THERAPY
• Flowing Function LLC
• FM Ocean Crest, LLC
• Jenifer Lynn Folau
• Paul Edward Forbes Jr., MSW, LCSW
• Leonard Duane Foreman Jr.
• Maria Elizabeth Forty, LMT
• Elizabeth Frakes, SLP, CCC-SLP

• Assisted Living Facility in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Assisted Living Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.