NPIMap

Organization Active NPI

Beaverton Rehab & Specialty Care, LLC

  • Skilled Nursing Facility
  • Beaverton, OR
National Provider Identifier
1366469330
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BEAVERTON REHAB & SPECIALTY CARE, LLC
Practice address
11850 SW Allen Blvd
Beaverton, OR 97005-4805
Phone
(503) 646-7164
NPI assigned
Jul 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Authorized official

Name
K. Rickard Miller Jr.
Title
Manager
Phone
(503) 570-3405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

11850 SW Allen Blvd
Beaverton, OR 97005-4805

Mailing address

25117 SW Parkway Ave
Suite F
Wilsonville, OR 97070-9697

Other names 1

  • Avamere Rehabilitation of Beaverton Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040130000799 OR Part B Supplier - Clinic/Group Practice 5799688230 Receives reassigned benefits from 3,391 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portland, OR; Salem, OR; Tigard, OR; Tualatin, OR; Mount Angel, OR; Beaverton, OR; Clackamas, OR; Eugene, OR…
O20070815000110 OR Part A Provider - Skilled Nursing Facility 0749188589 Practice locations: Beaverton, OR

Skilled nursing facility certification: CCN 385195

Legal name
BEAVERTON REHAB & SPECIALTY CARE, LLC
Doing business as
AVAMERE REHABILITATION OF BEAVERTON
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 8, 1989
Last certification
Mar 25, 2024
Beds
104
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Avamere
Most recent change of ownership
Dec 1, 2025
Organization structure
LLCProprietary
Enrollment address
11850 SW Allen Blvd
Beaverton, OR 97005-4805

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Beaverton Post Acute Care of CascadiaCCN 385195
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 8, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10478.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Permananet Clinic150 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3600 N Interstate Ave
Portland, OR 97227
Phone (503) 285-9321

5125 Skyline Rd S
Salem, OR 97306
Phone (503) 361-5400

19185 SW 90th Ave
Tualatin, OR 97062
Phone (503) 723-6699

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nair Operations LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
Karl Rickard Miller Individual 5% Or Greater Indirect Ownership Interest Oct 16, 2014 62.36%
Corporate OfficerCeo Sep 7, 2019
Nair SNF Operations LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
Robb Melcher Individual W-2 Managing EmployeeAd; Oct 1, 2023
Andrew Simpson Individual Corporate OfficerCfo Jun 1, 2024
Avamere Health Services LLC Organization, Wilsonville, OR LLC, For-profit Other Mar 23, 2015 100%
Nair LLC Organization, Wilsonville, OR LLC, Management services company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%
David P Larson Individual Contracted Managing EmployeeMD; Apr 1, 2021
Richard a Dillon Individual 5% Or Greater Indirect Ownership Interest Oct 16, 2014 31.18%
Ronald a Odermott Individual 5% Or Greater Indirect Ownership Interest Oct 16, 2014 6.46%
Mary Kofstad Individual Corporate OfficerCoo Feb 13, 2024
Nair Facility Holdings LLC Organization, Wilsonville, OR LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2024 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • PO SNF Operations LLC
    • Skilled Nursing Facility
    • Port Orchard, WA
    • NPI 1669151023

    Nair Facility Holdings LLC, Nair LLC, Nair Operations LLC, Nair SNF Operations LLC

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 88

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1366469330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE",
            "address_2": "SUITE F",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 SW ALLEN BLVD",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054805",
            "telephone_number": "503-646-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERTON REHAB & SPECIALTY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "K. RICKARD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-570-3405",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Avamere Rehabilitation of Beaverton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.