Parkside Living RTF

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

PARKSIDE LIVING RTF

Practice address

1525 SW Shirley Ann Dr
McMinnville, OR 97128-7665

Phone

(503) 472-9603

NPI assigned

Nov 21, 2008

Last updated

Nov 21, 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

Pooneh Entezari

Title

Owner

Phone

(503) 309-6202

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eleazar Jr. Aguilera-Reyes

  • Mental Health Counselor
  • McMinnville, OR
  • NPI 1649134651
  NPD (past)
• Cesar Garcia

  • Mental Health Counselor
  • McMinnville, OR
  • NPI 1437813011
  NPD (past)
• Dawn R Hall, RN

  • Registered Nurse
  • McMinnville, OR
  • NPI 1588396063
  NPD (past)

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

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1447405147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 N LOTUS BEACH DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972178021",
            "telephone_number": "503-309-6202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 SW SHIRLEY ANN DR",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971287665",
            "telephone_number": "503-472-9603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE LIVING RTF",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-21",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "ENTEZARI",
        "authorized_official_first_name": "POONEH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-309-6202"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Parkinson, RPH
• Parkland Village Limited Partnership (Parkland Village Assisted Living)
• Parko Inc (Mac Prescription Shop at PMC)
• Parko Inc (Mac Medical Shop)
• Parko, Inc. (Mac Prescription Shop)
• Rae Parlier, RN
• Megan Parr, BA, QMHA-R
• Michael Scott Passo, MD
• Troy Joseph Pastora
• Kishore Gopinathan Pathial, MD

• Mental Illness Community Based Residential Treatment Facility in McMinnville, OR
• Providers in McMinnville, OR by specialty
• Mental Illness Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.