Prestige Residential Community LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRESTIGE RESIDENTIAL COMMUNITY LLC

Doing business as

Elizabethan Manor

Practice address

44882 Mission Rd
Pendleton, OR 97801-9293

Phone

(541) 276-7157

Fax

(541) 276-3093

NPI assigned

Feb 27, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Gregory J Vislocky

Title

Managing Member

Phone

(360) 735-7155

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elizabethan Manor Doing business as

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144357310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 NE PARKWAY DR",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626648",
            "telephone_number": "360-735-7155",
            "fax_number": "360-735-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44882 MISSION RD",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019293",
            "telephone_number": "541-276-7157",
            "fax_number": "541-276-3093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE RESIDENTIAL COMMUNITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VISLOCKY",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "360-735-7155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "589713",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elizabethan Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Pozar, CRNA
• Praxis Health, PC (Pendleton Family Medicine Urgent Care)
• Praxis Health, PC (Pendleton Family Medicine)
• Praxis Health, PC (Pendleton Urgent Care)
• Praxis Health, PC (Eastern Oregon Orthopaedic Surgery & Fracture Clinic)
• Jennie Rebecca Price, MS CCC-SLP
• Kelly Dean Pridgen, MD
• Denise Prinkey
• Katherine Prose
• Trevor Prow

• Assisted Living Facility in Pendleton, OR
• Providers in Pendleton, 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 Aug 22, 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.