Evergreen Oregon Healthcare Portland, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1676 Issued in OR

Legal business name

EVERGREEN OREGON HEALTHCARE PORTLAND, L.L.C.

Doing business as

Portland Health and Rehabilitation Center

Practice address

12441 SE Stark St
Portland, OR 97233-1053

Phone

(503) 255-7040

Fax

(503) 255-0555

NPI assigned

May 5, 2006

Last updated

Jan 30, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

EMPRES OREGON HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Portland Health and Rehabilitation Center Doing business as

Locations

Practitioners 1

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.

• Mark W Cheng, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Portland, OR
  • NPI 1871899740
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1497703110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12441 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331053",
            "telephone_number": "503-255-7040",
            "fax_number": "503-255-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OREGON HEALTHCARE PORTLAND, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES OREGON HEALTHCARE, LLC",
        "enumeration_date": "2006-05-05",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OR",
            "license": "1676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800000",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Evergreen Counseling LLC
• Evergreen Health LLC
• Evergreen Hospital Dentistry
• Evergreen Integrative Medicine, LLC (NW Functional Thyroid Clinic)
• Evergreen Medical Solutions LLC
• Evergreen Pelvic Health and Wellness LLC
• Evergreen Pharmaceutical LLC (Omnicare of Portland #48329)
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC
• Evergreen Prosthetics and Orthotics, LLC

• 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 Jan 30, 2017; 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.