Meadowland Adult Foster Home LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

500697789 Issued in OR

Legal business name

MEADOWLAND ADULT FOSTER HOME LLC

Practice address

706 Meadow Ave
Tillamook, OR 97141-2844

Phone

(503) 354-2523

Fax

(503) 354-5116

NPI assigned

Jun 3, 2016

Last updated

Jun 24, 2016By 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

Mr. Sujay Kumar NakkaNPI 1932654118

Title

Owner

Phone

(503) 354-2523

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Sujay Nakka

  • Case Manager/Care Coordinator
  • Tillamook, OR
  • NPI 1932654118
  NPD (past) Authorized official
• Cory Baird

  • Case Manager/Care Coordinator
  • Tillamook, OR
  • NPI 1659833341
  NPD (past)

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1508215252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 MEADOW AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971412844",
            "telephone_number": "503-354-2523",
            "fax_number": "503-354-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 MEADOW AVE",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971412844",
            "telephone_number": "503-354-2523",
            "fax_number": "503-354-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOWLAND ADULT FOSTER HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "NAKKA",
        "authorized_official_first_name": "SUJAY",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-354-2523",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "OR",
            "license": "500697789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gene McColgin, M.D.
• Portia T McGowan
• Aubrey Rain McLoud
• Michael K McRobert
• Priscilla McRobert, THW
• Benius Karl Meier Jr., M.D.
• Perla Yadira Mendez
• Beatrice H Michel, OD
• Middle Way Health Care LLC
• Allison Miller, RN

• Assisted Living Facility (Behavioral Disturbances) in Tillamook, OR
• Providers in Tillamook, OR by specialty
• Assisted Living Facility (Behavioral Disturbances) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; 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.