Organization Active NPI

Portland SNF Operations, LLC

  • Skilled Nursing Facility
  • Portland, OR
National Provider Identifier
1104530492
Registry record updated Sep 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PORTLAND SNF OPERATIONS, LLC
Practice address
12441 SE Stark St
Portland, OR 97233-1053
Phone
(503) 255-7040
NPI assigned
Jan 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2024

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

Authorized official

Name
Yitzchok Yenowitz
Title
Authorized Representative
Phone
(323) 333-0910

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Registered Respiratory TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 227900000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

12441 SE Stark St
Portland, OR 97233-1053

Mailing address

1777 Avenue of the States Ste 102
Lakewood, NJ 08701-4779
Phone (732) 366-8300

Other names 1

  • Portland Health & Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231018001197 OR Part A Provider - Skilled Nursing Facility 3870948391 Practice locations: Portland, OR

Skilled nursing facility certification: CCN 385228

Legal name
PORTLAND SNF OPERATIONS LLC
Doing business as
PORTLAND HEALTH & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1992
Last certification
Oct 29, 2024
Beds
105
Ownership / control type
Corporation
Multi-facility organization
EVERGREEN HEALTH CARE
Organization structure
LLCProprietary
Enrollment address
12441 SE Stark St
Portland, OR 97233-1053
Nursing home name
PORTLAND HEALTH AND REHABILITATION
Affiliated entity
EVERGREEN HEALTHCARE GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Portland Health and RehabilitationCCN 385228
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10555.2 residents per day on average
Chain
Evergreen Healthcare Group44 facilities in the chain
Penalties (3 years)
1Fines totaling $24,827

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

12441 SE Stark St
Portland, OR 97233
Phone (503) 225-7040

Ownership & related parties

All disclosed owners & managing parties 24

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Organization, Lakewood, NJ LLC, For-profit Adp of the SNF Aug 31, 2023
Witzcorp Global LLC Organization, Lakewood, NJ LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 31, 2023 25%
Adp of the SNF Aug 31, 2023
Indirect Ownership Interest Aug 31, 2023 25%
Pacific Northwest SNF Operations Holdings LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest Aug 31, 2023 100%
Couve Healthcare Consulting LLC Organization, Vancouver, WA LLC, Consulting firm, For-profit Operational/Managerial Control Aug 31, 2023
Adp of the SNF Mar 31, 2025
Duffy Dezember Individual Operational/Managerial Control Aug 31, 2023
Adp of the SNF Aug 31, 2023
Couve Financial Services LLC Organization, Vancouver, WA LLC, Management services company, For-profit, Chain home office Operational/Managerial Control Aug 31, 2023
Adp of the SNF Aug 31, 2023
Organization, Lakewood, NJ Indirect Ownership Interest Aug 31, 2023 2.25%
Organization, Lakewood, NJ LLC, Private equity company, Owned by another organization or individual Indirect Ownership Interest Aug 31, 2023 3%
Portland SNF Operations LLC Organization, Portland, OR LLC, For-profit Operational/Managerial Control Aug 31, 2023
Adp of the SNF Jun 18, 2025
Direct Ownership Interest Aug 31, 2023
Mylene Cepeda Individual Managing Control - Governing BodyDdco Aug 31, 2023
Adp of the SNF Aug 31, 2023
Pacific Northwest Opco Management LLC Organization, Lakewood, NJ LLC, Management services company, For-profit Operational/Managerial Control Aug 31, 2023
Adp of the SNF Apr 1, 2025
Organization, Lakewood, NJ Indirect Ownership Interest Aug 31, 2023 2.25%
Individual Indirect Ownership Interest Aug 31, 2023 1%
Yitzchok Yenowitz Individual Operational/Managerial ControlChief Executive Officer Aug 31, 2023 100%
Adp of the SNF Aug 31, 2023
Indirect Ownership Interest Aug 31, 2023 25%
Yisroel E Herzka Individual Adp of the SNF Aug 31, 2023
Indirect Ownership Interest Aug 31, 2023 66.5%
Oregon SNF Consulting LLC (de) Organization, Lakewood, NJ LLC, Consulting firm, For-profit Operational/Managerial Control Aug 31, 2023
Adp of the SNF Apr 1, 2025
Pacific Northwest SNF Operations Holdings (Or) LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual Direct Ownership Interest Aug 31, 2023 100%
Christopher R Morris Individual Operational/Managerial Control Aug 31, 2023
Adp of the SNF Aug 31, 2023
Shimon Spielman Individual Operational/Managerial Control Aug 31, 2023
Adp of the SNF Aug 31, 2023
Organization, Lakewood, NJ LLC, Private equity company, Owned by another organization or individual Indirect Ownership Interest Aug 31, 2023 1%
Jason Odenthal Individual Operational/Managerial Control Aug 31, 2023
Managing Control - Governing Body Aug 31, 2023
Adp of the SNF Aug 31, 2023
CH Pacific Northwest Holdings LLC Organization, Lakewood, NJ LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 31, 2023 66.5%
Adp of the SNF Aug 31, 2023
Indirect Ownership Interest Aug 31, 2023 66.5%
Individual Indirect Ownership Interest Aug 31, 2023 3%
Basiru Ceesay Individual Operational/Managerial Control Aug 31, 2023
Adp of the SNF Aug 31, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 51

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 51

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1104530492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 AVENUE OF THE STATES STE 102",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014779",
            "telephone_number": "732-366-8300",
            "fax_number": "732-523-5312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12441 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331053",
            "telephone_number": "503-255-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND SNF OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-11",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "YENOWITZ",
        "authorized_official_first_name": "YITZCHOK",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "323-333-0910"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "227900000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Respiratory Therapist, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Portland Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.