Forest Drive Operations, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1847571968 Issued in OR

Legal business name

FOREST DRIVE OPERATIONS, LLC

Doing business as

Suzanne Elise Assisted Living Facility

Practice address

101 Forest Dr
Seaside, OR 97138-7867

Phone

(503) 738-0307

Fax

(503) 717-8102

NPI assigned

Jul 28, 2008

Last updated

Jul 28, 2008By 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. Karl Rickard Miller Jr.

Title

Owner

Phone

(503) 570-3405

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Suzanne Elise Assisted Living Facility Doing business as

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1306001474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 FOREST DR",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971387867",
            "telephone_number": "503-738-0307",
            "fax_number": "503-717-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FOREST DR",
            "city": "SEASIDE",
            "state": "OR",
            "postal_code": "971387867",
            "telephone_number": "503-738-0307",
            "fax_number": "503-717-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST DRIVE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KARL",
        "authorized_official_middle_name": "RICKARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-570-3405",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OR",
            "license": "1847571968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "517786",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suzanne Elise Assisted Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Priscilla P Fairall, LABOR DOULA
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• Diana Rose Fischer, PHARMD
• Casseopia Fisher, AGACNP
• Kathleen Renee Flewelling, N.D.
• Michael J Forrest, P.A.
• Lisa Ann French, LMT
• Kaylin Faith Gaunt
• Tamara Gedrose, RN
• Gibbs Natural Healing Centre, PC

• Assisted Living Facility in Seaside, OR
• Providers in Seaside, 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 Jul 28, 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.