Sssht Opco SE Division Street, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SSSHT OPCO SE DIVISION STREET, LLC

Doing business as

Courtyard at Mt. Tabor

Practice address

6323 SE Division St
Portland, OR 97206-1385

Phone

(503) 772-9795

NPI assigned

Jun 9, 2022

Last updated

Jun 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Todd Pile

Title

Senior Executive Director

Phone

(503) 788-0896

Specialties & licenses 1

Addresses

Other names 1

• Courtyard at Mt. Tabor 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

Locations

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1861121311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6125 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061304",
            "telephone_number": "503-788-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6323 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061385",
            "telephone_number": "503-772-9795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 SE 60th Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972154076",
            "country_code": "US",
            "telephone_number": "503-446-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SSSHT OPCO SE DIVISION STREET, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "PILE",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "SENIOR EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "503-788-0896",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courtyard at Mt. Tabor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Renganathan Srinivasan, M.D.
• June Suparatana Srisethnil, PT
• Amar Srivastava, M.D.
• Rungrudee Sriyoung, RN
• Ann Elizabeth Srodulski, MA
• Michael Anthony St Amand, PAC
• Karen St Clair, LCSW
• Keeley Swete St Clair, MT-BC
• Pamela Jean St Clair, FNP-BC
• Rene C St Cyr, DC

• Assisted Living Facility in Portland, OR
• Providers in Portland, 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 9, 2022; 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.