Greenridge Estates Operating LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GREENRIDGE ESTATES OPERATING LLC

Practice address

4 Greenridge Dr
Lake Oswego, OR 97035-1400

Phone

(503) 635-8818

NPI assigned

Jun 23, 2020

Organization subpart

No

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

Authorized official

Name

Winston Tonack

Title

Owner

Phone

(503) 550-7170

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1558987768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GREENRIDGE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 GREENRIDGE DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351400",
            "telephone_number": "503-635-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENRIDGE ESTATES OPERATING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "TONACK",
        "authorized_official_first_name": "WINSTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-550-7170"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526417",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Christian Gray, DNP, PMHNP
• Heather Green-Bostwick, L.M.T.
• Edward Carl Green, CWOCN
• Michael Sean Green, M.D.
• Meaghan Greene
• Nancy Marie Gregory, RN
• Gretchen Gulotta, LLC
• Alexander William Griego
• Robert Grimm, RPH
• Linda Karen Griswold, LPC

• Assisted Living Facility in Lake Oswego, OR
• Providers in Lake Oswego, 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 23, 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.