FM Princeton, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FM PRINCETON, LLC

Practice address

14370 SE Oregon Trail Dr
Clackamas, OR 97015-6290

Phone

(503) 558-1215

Fax

(503) 558-8437

NPI assigned

Jun 19, 2020

Organization subpart

No

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

Authorized official

Name

Gregory Roderick

Title

Member

Phone

(503) 443-1818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Princeton Village Assisted Living 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": "1592524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592524800000",
    "number": "1780200337",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14370 SE OREGON TRAIL DR",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970156290",
            "telephone_number": "503-558-1215",
            "fax_number": "503-558-8437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FM PRINCETON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-19",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A",
        "authorized_official_last_name": "RODERICK",
        "authorized_official_first_name": "GREGORY",
        "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": "527962",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Princeton Village Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lynda Lynell Gigstad Fitzpatrick, AU.D.
• Scott Ellison Fitzwater, LPC CADC III
• Jennifer Ann Fleischer
• Kristian Elijah Flores, MD
• Channing Danae Flury, PMHNP
• Amanda Fobare, M.D.
• Sierra C Ford, D.O.
• Matthew Forsyth, MD
• Benjamin Foss, RRT
• Erik William Foss, MD

• Assisted Living Facility in Clackamas, OR
• Providers in Clackamas, 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 19, 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.