Mirabella at South Waterfront

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MIRABELLA AT SOUTH WATERFRONT

Practice address

3550 S Bond Ave
Portland, OR 97239-4507

Phone

(503) 688-6400

NPI assigned

Jun 18, 2010

Organization subpart

No

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

Authorized official

Name

Sharon Van Eaton

Title

Executive Director

Phone

(503) 901-2939

Specialties & licenses 5

Addresses

Other names 1

• Mirabella Portland Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Skilled nursing facility certification: CCN 385274

Legal name

MIRABELLA AT SOUTH WATERFRONT

Doing business as

MIRABELLA PORTLAND

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Feb 3, 2011

Last certification

Nov 25, 2024

Beds

44

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Nov 21, 2006 in OR

Enrollment address

3550 S Bond Ave
Portland, OR 97239-4507

Nursing home name

MIRABELLA PORTLAND

Affiliated entity

PACIFIC RETIREMENT SERVICES

Listed as

Mirabella PortlandCCN 385274

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

Non profit - Corporation

Certified

Feb 3, 2011

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4424.0 residents per day on average

Chain

Pacific Retirement Services10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 9

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

Owners & managing parties with NPI records 1

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

• Emily Ames Morgan, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1619267200

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 5

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

• Laura K Byerly, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Portland, OR
  • NPI 1568726024

  Nursing home

  Care Compare affiliation
• Elizabeth Nancy Eckstrom, MD, MPH

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1538266309

  Nursing home

  Care Compare affiliation
• Emily Ames Morgan, M.D.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1619267200

  Nursing home

  Care Compare affiliation
• Suvi Neukam, D.O.

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1376939876

  Nursing home

  Care Compare affiliation
• Kevin Munson O'Brien, MSN, FNP-C, APRN

  • Family Nurse Practitioner
  • Portland, OR
  • NPI 1295345767

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1487975959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 S BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394507",
            "telephone_number": "503-688-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 S BOND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972394507",
            "telephone_number": "503-688-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRABELLA AT SOUTH WATERFRONT",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "VAN EATON",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-901-2939"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OR",
            "license": "1291022896",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "OR",
            "license": "1753514587",
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OR",
            "license": "1233196437",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mirabella Portland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ava Minu-Sepehr
• Karen Ellen Minzer-Conzetti, M.D.
• Miozen Clinic Massage LLC
• Abeer Ahmed Miqad
• Mickey Miqueli-Piazza, ARNP
• Lucas Anthony Mirabito, PHD
• Miracle RTH LLC
• Lori Kristen Miracle, L.AC
• Miraclepoint Medical Transportation Services LLC
• Alexander C Miramontes

• Skilled Nursing Facility in Portland, OR
• Providers in Portland, 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 Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.