Beaverton Hills Assisted Living Residence, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

BEAVERTON HILLS ASSISTED LIVING RESIDENCE, LLC

Doing business as

Beaverton Hills Assisted Living Residence

Practice address

3220 State St
Suite 200
Salem, OR 97301-6872

Phone

(503) 566-5715

Fax

(506) 588-3531

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kelley D Hamilton

Title

Ceo-President of Manager

Phone

(503) 566-5715

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beaverton Hills Assisted Living Residence Doing business as

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1568674034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 SW 99TH AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970053342",
            "telephone_number": "503-520-1350",
            "fax_number": "503-671-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 STATE ST",
            "address_2": "SUITE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016872",
            "telephone_number": "503-566-5715",
            "fax_number": "506-588-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERTON HILLS ASSISTED LIVING RESIDENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO-PRESIDENT OF MANAGER",
        "authorized_official_telephone_number": "503-566-5715",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTRY #",
            "identifier": "72220586",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaverton Hills Assisted Living Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Duane Gary Beard, MD
• Shannon Beard, LCSW
• Dan A Beaver, DO
• Michael P Beaver, LCSW
• Taylor Beavers, PA
• Wendy Beavis, THW BS PSS
• Heather Lynn Bechtel, ATC
• William J Beck, PHARM.D.
• Jerry R Becker, MD
• Laurel Becker

• Point of Service in Salem, OR
• Providers in Salem, OR by specialty
• Point of Service in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; 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.