NPIMap

Organization Active NPI

State of Oregon Department of Veterans' Affairs

  • Skilled Nursing Facility
  • Lebanon, OR
National Provider Identifier
1679985113
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STATE OF OREGON DEPARTMENT OF VETERANS' AFFAIRS
Practice address
600 N. 5TH Street
Lebanon, OR 97355
Phone
(503) 362-5235
NPI assigned
Jun 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Authorized official

Name
Bruce Shriver
Title
Chief Financial Officer
Phone
(503) 373-2268

Specialties & licenses 1

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

Addresses

Primary practice location

600 N. 5TH Street
Lebanon, OR 97355

Mailing address

600 N. 5TH Street
Lebanon, OR 97355
Phone (503) 362-5235

Other identifiers 1

IdentifierTypeStateIssuer
500681197MedicaidOR

Other names 1

  • Oregon Veterans Home - Lebanon Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150309000415 OR Part A Provider - Skilled Nursing Facility 4789675000 Practice locations: Lebanon, OR

Skilled nursing facility certification: CCN 385280

Legal name
STATE OF OREGON DEPARTMENT OF VETERANS AFFAIRS
Doing business as
LEBANON VETERANS HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 26, 2014
Last certification
May 3, 2024
Beds
154
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
600 N 5TH St
Lebanon, OR 97355-2876
Nursing home name
LEBANON VETERANS HOME

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lebanon Veterans HomeCCN 385280
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Dec 26, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
154144.1 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2080655Oregon Veterans Home- Lebanon600 N 5TH St, Lebanon, OR 97355Certificate of waiverJul 10, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Veterans Care Centers of Oregon Organization, Salem, OR Non-profit Operational/Managerial Control Oct 1, 2014 100%
State of Oregon Department of Veterans Affairs Organization, Salem, OR 5% Or Greater Direct Ownership Interest Oct 1, 2014 100%
Westcare Management Inc Organization, Salem, OR For-profit Operational/Managerial Control Oct 1, 2014 100%
Donna K Haole Valenzuela Individual W-2 Managing EmployeeChief Financial Officer Mar 1, 2022 100%
Bryan Decker Individual Operational/Managerial ControlPresident Jun 14, 2022 100%
Abraham Andrade Individual W-2 Managing EmployeeExecutive Director Jun 14, 2022 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Oregon Veterans HomeThe Dalles, OR, CCN 385257 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2003

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1679985113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 N. 5TH STREET",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "97355",
            "telephone_number": "503-362-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N. 5TH STREET",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "97355",
            "telephone_number": "503-362-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF OREGON DEPARTMENT OF VETERANS' AFFAIRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "SHRIVER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "503-373-2268"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500681197",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oregon Veterans Home - Lebanon",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.