Bend Villa Retirement, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1989448188 Issued in OR

Legal business name

BEND VILLA RETIREMENT, LLC

Practice address

1801 NE Lotus Dr
Bend, OR 97701-6174

Phone

(541) 389-0046

Fax

(541) 382-1239

NPI assigned

Jun 20, 2008

Organization subpart

No

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

Authorized official

Name

Elizabeth Marie Moss

Title

Director of Risk Management

Phone

(503) 588-2725

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bend Villa Retirement Doing business as

Locations

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1295996338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE AVE SE STE A140",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973015092",
            "telephone_number": "503-588-2725",
            "fax_number": "503-588-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 NE LOTUS DR",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016174",
            "telephone_number": "541-389-0046",
            "fax_number": "541-382-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEND VILLA RETIREMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF RISK MANAGEMENT",
        "authorized_official_telephone_number": "503-588-2725"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OR",
            "license": "1989448188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518082",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bend Villa Retirement",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Bend, OR
• Providers in Bend, 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 20, 2008; 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.