NPIMap

Organization Active NPI

Rogue Valley Manor

  • Skilled Nursing Facility
  • Medford, OR
National Provider Identifier
1639170988
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2275 Issued in OR
Legal business name
ROGUE VALLEY MANOR
Practice address
1200 Mira Mar Ave
Medford, OR 97504-8546
Phone
(541) 857-7777
Fax
(541) 857-7590
NPI assigned
Aug 9, 2005
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Melissa Preston
Title
Asst. Executive Director
Phone
(541) 857-7392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2275 OR Primary

Addresses

Primary practice location

1200 Mira Mar Ave
Medford, OR 97504-8546

Mailing address

1200 Mira Mar Ave
Medford, OR 97504-8546
Phone (541) 857-7777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050804000606 OR Part A Provider - Skilled Nursing Facility 8921037573 Practice locations: Medford, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639170988. Details of each certification follow.

Skilled nursing facility certification: CCN 385250

Legal name
ROGUE VALLEY MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Dec 7, 1995
Last certification
Apr 24, 2025
Beds
68
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Pacific Retirement Services
Organization structure
CorporationNon-profit
Incorporated
Nov 2, 1955 in OR
Enrollment address
1200 Mira Mar Ave
Medford, OR 97504-8546
Nursing home name
ROGUE VALLEY MANOR
Affiliated entity
PACIFIC RETIREMENT SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Rogue Valley ManorCCN 385250 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare
Ownership
Non profit - Corporation
Certified
Dec 7, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6828.8 residents per day on average
Chain
Pacific Retirement Services10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Rogue Valley Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Anirudh K Bhasin Individual Corporate DirectorDirector Oct 1, 2015
Timothy Brophy Individual Corporate DirectorDirector Jul 12, 2021
Stan J Solmonson Individual Corporate DirectorBoard Member Apr 13, 2020
W-2 Managing EmployeeExecutive Director Apr 13, 2020
William Jacobs Individual Corporate DirectorDirector Oct 1, 2019
Carl a Christlieb Individual Corporate DirectorDirector Apr 15, 2013
Fredric J Willms Individual Corporate DirectorBoard Vice Chair Apr 15, 2013
Julie Beattie Individual Corporate DirectorDirector Jan 10, 2022
Russell R Heysell Individual Corporate DirectorBoard Secretary Apr 15, 2014
April L Sevick Individual Corporate DirectorBoard Treasurer Apr 15, 2013
Pacific Retirement Services Inc Organization, Medford, OR Corporation, Non-profit Operational/Managerial Control Oct 1, 1996 100%
US Bank National Association Organization, Portland, OR Corporation, Financial institution, For-profit 5% Or Greater Security Interest Dec 1, 2007 100%
Eric Sholty Individual Corporate OfficerCeo May 27, 2018
Robert W Mayers Individual Corporate DirectorDirector Apr 15, 2013

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1639170988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048546",
            "telephone_number": "541-857-7777",
            "fax_number": "541-857-7590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MIRA MAR AVE",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048546",
            "telephone_number": "541-857-7777",
            "fax_number": "541-857-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE VALLEY MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "PRESTON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "ASST. EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-857-7392"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OR",
            "license": "2275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.