FM Cedar Village, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FM CEDAR VILLAGE, LLC

Doing business as

Cedar Village Assisted Living & Memory Care

Practice address

4452 Lancaster Dr NE
Salem, OR 97305-1697

Phone

(503) 390-9600

Fax

(503) 390-9152

NPI assigned

Jun 18, 2020

Organization subpart

No

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

Authorized official

Name

Gregory A Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Cedar Village Assisted Living & Memory Care Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1720604499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-597-4906",
            "fax_number": "503-443-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4452 LANCASTER DR NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051697",
            "telephone_number": "503-390-9600",
            "fax_number": "503-390-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FM CEDAR VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "503-443-1818"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526908",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526907",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Village Assisted Living & Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marcel Flores, PSY.D.
• Ruben Flores
• Christina Renee Flowers, CADC-R
• Mercedes Floyd, RN
• April Flynn
• FM Redwood Heights, LLC (Redwood Heights Assisted Living)
• Caleb Spencer Fogle, PH.D
• Mark E Foglesong, MD
• Brandy G Foht, CADC-R
• Cory Folkert

• Assisted Living Facility in Salem, OR
• Providers in Salem, 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 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.