Pacific Northwest Living LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PACIFIC NORTHWEST LIVING LLC

Practice address

4392 Coloma Dr SE
Salem, OR 97302-5076

Phone

(971) 301-8831

Fax

(971) 301-8862

NPI assigned

Jan 8, 2021

Organization subpart

No

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

Authorized official

Name

Rosella Mary Miltimore, OWNER/OPERATOR

Title

Executive Director

Phone

(503) 765-0454

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pacific Northwest Living LLC Doing business as

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1225626765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4392 COLOMA DR SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973025076",
            "telephone_number": "503-765-0454",
            "fax_number": "971-301-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4392 COLOMA DR SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973025076",
            "telephone_number": "971-301-8831",
            "fax_number": "971-301-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NORTHWEST LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "MILTIMORE",
        "authorized_official_first_name": "ROSELLA",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-765-0454",
        "authorized_official_credential": "OWNER/OPERATOR"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DZ1463",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGENCY CERTIFICATE DEVELOPMENTAL DISABILITY",
            "identifier": "DZ1463",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Northwest Living LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pacific Family Medical Center LLC
• Pacific Family Medical Center LLC
• Pacific Family Medical Center LLC
• Pacific Medical, Inc.
• Pacific Northwest Counseling & Consultation LLC
• Pacific Northwest Medical Transport Service, Inc
• Pacific Northwest Sleep Centers, LLC
• Pacific Obstetrics & Gynecology, L.L.C.
• Pacific Pathology Associates, Inc
• Pacific Pathology Associates, Inc

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Salem, OR
• Providers in Salem, OR by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.