NPIMap

Organization Active NPI

Gresham of Cascadia, LLC

  • Skilled Nursing Facility
  • Gresham, OR
National Provider Identifier
1417667262
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GRESHAM OF CASCADIA, LLC
Practice address
3457 NE Division St
Gresham, OR 97030-4602
Phone
(208) 401-9600
Fax
(208) 314-0639
NPI assigned
Dec 2, 2022
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
Owen Hammond
Title
President
Phone
(208) 401-9600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3457 NE Division St
Gresham, OR 97030-4602

Mailing address

2205 E Riverside Dr Ste 100
Eagle, ID 83616-7621
Phone (208) 401-9600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230601002953 OR Part A Provider - Skilled Nursing Facility 3678930831 Practice locations: Gresham, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417667262. Details of each certification follow.

Skilled nursing facility certification: CCN 385133

Legal name
GRESHAM OF CASCADIA, LLC
Doing business as
FAIRLAWN HEALTH AND REHABILITATION OF CASCADIA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 14, 1976
Last certification
Dec 6, 2024
Beds
82
Ownership / control type
Corporation
Multi-facility organization
Cascadia Health Care
Organization structure
LLCProprietary
Incorporated
Nov 30, 2022 in DE
Enrollment address
3457 NE Division St
Gresham, OR 97030-4602
Nursing home name
FAIRLAWN HEALTH AND REHABILITATION OF CASCADIA
Affiliated entity
CASCADIA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fairlawn Health and Rehabilitation of CascadiaCCN 385133 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 14, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8274.6 residents per day on average
Chain
Cascadia Healthcare46 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0621923Fairlawn Health and Rehabilitation of Cascadia3457 NE Division Street, Gresham, OR 97030Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory

Locations

3457 NE Division St
Gresham, OR 97030
Phone (503) 447-6955

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
Cascadia Services LLC Organization, Eagle, ID LLC Operational/Managerial Control Nov 30, 2022
Adp of the SNF Apr 10, 2025
Cascadia HC Group LLC Organization, Eagle, ID LLC Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 100%
Leslie Workman Individual Operational/Managerial Control Feb 19, 2024
Adp of the SNF Feb 26, 2025
Cascadia Healthcare LLC Organization, Eagle, ID LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Apr 1, 2023
Indirect Ownership Interest Apr 1, 2023 100%
Stephen J Laforte Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Owen C Hammond Individual Operational/Managerial Control Apr 1, 2023
Indirect Ownership Interest Apr 1, 2023
Gresham 3457 Realty, LLC Organization, New York, NY LLC, Owned by another organization or individual 5% Or Greater Security Interest Jun 5, 2025 100%
Adp of the SNF Jun 5, 2025
White Oak Healthcare Finance LLC Organization, New York, NY LLC, Financial institution, Owned by another organization or individual 5% Or Greater Security Interest Aug 11, 2022 100%
Cascadia Holdco LLC Organization, Eagle, ID LLC Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 100%
Timothy Nelson Individual Operational/Managerial Control Jun 5, 2025
Indirect Ownership Interest Jun 5, 2025 33.33%
Nita Vellody Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Feb 26, 2025
Cascadia Oregon Operations LLC Organization, Eagle, ID LLC Operational/Managerial Control Apr 1, 2023
Direct Ownership Interest Apr 1, 2023 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 46

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

View all 46

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1669939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1417667262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 E RIVERSIDE DR STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167621",
            "telephone_number": "208-401-9600",
            "fax_number": "208-314-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3457 NE DIVISION ST",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970304602",
            "telephone_number": "208-401-9600",
            "fax_number": "208-314-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM OF CASCADIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-02",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "HAMMOND",
        "authorized_official_first_name": "OWEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-401-9600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

Verify at the official NPI Registry.