FM Pheasant Pointe, LLC
Organization Active NPI Assisted Living Facility · Molalla, OR
NPI 1801412432 · NPPES record last updated Jun 19, 2020
Key facts
- NPI
- 1801412432
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- Legal business name
- FM PHEASANT POINTE, LLC
- Practice address
- 835 E Main St
Molalla, OR 97038-8117 - Phone
- (503) 829-3777
- NPI assigned
- Jun 19, 2020
- Organization subpart
- No
Authorized official
- Name
- Gregory Roderick
- Title
- Member
- Phone
- (503) 443-1818
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2171682 | Pheasant Pointe Assisted Living & Memory Care | Certificate of waiver | Sep 5, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | Yes |
Addresses
Primary practice location
835 E Main St
Molalla, OR 97038-8117
Mailing address
7420 SW Bridgeport Rd Ste 105
Portland, OR 97224-7790
Phone (503) 597-4906
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 526917 | Medicaid | OR | |
| 526916 | Medicaid | OR |
Other names
- Pheasant Pointe Assisted Living and Memory Care
Other providers in Molalla, OR
- Ronald P Dulwick
- Tori L Dulwick
- Michelle R Eide
- Erica Garfield
- Floyd Family Orthodontics Holdings LLC
- Foothills Community Church
- Erin Kaleena Fortuna
- Sabrina Marie Frolov
- Juliann Fronius
- Rachel Fudge
All providers in Molalla, OR · Assisted Living Facility in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.