Portland Assisted Living Facility

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL12536 Issued in FL

Legal business name

PORTLAND ASSISTED LIVING FACILITY

Doing business as

Portland ALF

Practice address

4664 NW 58TH Ter
Coral Springs, FL 33067-2115

Phone

(954) 603-6954

NPI assigned

Apr 3, 2015

Organization subpart

Yes

Parent organization

PORTLAND HEALTHCARE INCAs reported in NPPES

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

Authorized official

Name

Mr. Randy S Moodie, PHARM.D

Title

Administrator

Phone

(561) 870-8546

Specialties & licenses 1

Addresses

Other names 1

• Portland ALF Doing business as

Part of

Portland Assisted Living Facility

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1326433681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8758 COBBLESTONE POINT CIR",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334724458",
            "telephone_number": "561-870-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 NW 58TH TER",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330672115",
            "telephone_number": "954-603-6954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND ASSISTED LIVING FACILITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PORTLAND HEALTHCARE INC",
        "enumeration_date": "2015-04-03",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "MOODIE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "561-870-8546",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL12536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katelyn Sarah Popick
• Yael Porat
• Nancy Porras, RNFA
• Carla Porter, APRN
• Maria Portilla, D.M.D.
• Argentina Portocarrero
• David Porudominsky, MD
• Rony Porudominsky, MD
• Aaron L Porzio-Diaz, APRN
• Pos Med Corp

• Assisted Living Facility in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; 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.