Coast Fork Nursing Center Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COAST FORK NURSING CENTER INC

Practice address

515 Grant Ave
Cottage Grove, OR 97424-2967

Phone

(541) 942-5528

Fax

(541) 942-2155

NPI assigned

Sep 21, 2005

Organization subpart

No

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

Authorized official

Name

Gregory J Vislocky

Title

Exec. VP of Finance

Phone

(360) 735-7155

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coast Fork Nursing Center Doing business as

Practitioners 1

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

• Rick Brian Delamarter, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Santa Monica, CA
  • NPI 1780615336
  NPD (past)

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407842800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 NE PARKWAY DR",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626648",
            "telephone_number": "360-735-7155",
            "fax_number": "360-735-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 GRANT AVE",
            "city": "COTTAGE GROVE",
            "state": "OR",
            "postal_code": "974242967",
            "telephone_number": "541-942-5528",
            "fax_number": "541-942-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST FORK NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VISLOCKY",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXEC. VP OF FINANCE",
        "authorized_official_telephone_number": "360-735-7155"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "809244",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Fork Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kailene Ching
• Jennifer J Christopher, LMT
• Lennee Clark, PSS
• Valeria LF Clarke, LCSW
• Kathryn Cleland, QMHA
• Haley Cochell
• Sara Cochrane, L.M.T.
• Lesa Beth Collins Eller
• Shary Conley, LPN
• Ann Marie Cooley, MD

• Skilled Nursing Facility in Cottage Grove, OR
• Providers in Cottage Grove, OR by specialty
• Skilled Nursing Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.