NPIMap

Organization Active NPI

Russellville III LLC

Doing business as Russellville Park

  • Assisted Living Facility
  • Portland, OR
National Provider Identifier
1164845921
Registry record updated Jan 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
RUSSELLVILLE III LLC
Doing business as
Russellville Park
Practice address
23 SE 103Rd Ave
Portland, OR 97216
Phone
(503) 254-5900
NPI assigned
Jan 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2014

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

Authorized official

Name
Mr. Rayn Rasar
Title
VP Operations
Phone
(206) 436-7827

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

23 SE 103Rd Ave
Portland, OR 97216

Mailing address

23 SE 103Rd Ave
Portland, OR 97216
Phone (503) 254-5900

Other names 1

  • Russellville Park Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1391040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1164845921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 SE 103RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-254-5900",
            "fax_number": "503-255-7098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 SE 103RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97216",
            "telephone_number": "503-254-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE III LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-30",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "RASAR",
        "authorized_official_first_name": "RAYN",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "206-436-7827",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russellville Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2014; 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.