FM Pelican, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FM PELICAN, LLC

Practice address

615 Washburn Way
Klamath Falls, OR 97603-3685

Phone

(541) 882-8900

NPI assigned

Jun 19, 2020

Organization subpart

No

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

Authorized official

Name

Gregory Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Pelican Pointe Assisted Living and Memory Care Doing business as

Locations

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

{
    "created_epoch": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1497371025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-597-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 WASHBURN WAY",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976033685",
            "telephone_number": "541-882-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FM PELICAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-443-1818"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "527509",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "527434",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelican Pointe Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cody Flanders
• Jessica Marie Flescher
• Anahi Flores
• Samantha Laura Flores
• Bilson Florvilus
• Jayde A Foerstel
• Olawale Akinleye Folarin, PHD, MSC., QMHP
• Sara T Folden, M.D.
• Cinda L Folsom, CADC I
• Makenzie F Folsom

• Assisted Living Facility in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Assisted Living Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.