FM Ocean Crest, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FM OCEAN CREST, LLC

Practice address

192 Norman Ave
Coos Bay, OR 97420-4741

Phone

(541) 888-2255

Fax

(541) 888-5908

NPI assigned

Jun 18, 2020

Organization subpart

No

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

Authorized official

Name

Gregory A Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bayside Terrace Assisted Living and Memory Care Doing business as

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1124644877",
    "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",
            "fax_number": "503-443-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 NORMAN AVE",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974204741",
            "telephone_number": "541-888-2255",
            "fax_number": "541-888-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FM OCEAN CREST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "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": "526904",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526920",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayside Terrace Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robin Sue Finney, PMHNP
• Carrie Lynn Fisher
• Treavor Fisher, D.D.S.
• Brandy Flood, MASSAGE THERAPY
• Flowing Function LLC
• FM Ocean Ridge, LLC
• Jenifer Lynn Folau
• Paul Edward Forbes Jr., MSW, LCSW
• Leonard Duane Foreman Jr.
• Maria Elizabeth Forty, LMT

• 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 18, 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.