NPIMap

Organization Active NPI

Dallas Health Care Center L L C

Doing business as Dallas Retirement Village Health Center

  • Skilled Nursing Facility
  • Dallas, OR
National Provider Identifier
1902140171
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DALLAS HEALTH CARE CENTER L L C
Doing business as
Dallas Retirement Village Health Center
Practice address
377 NW Jasper St
Dallas, OR 97338-1279
Phone
(503) 623-5581
Fax
(503) 623-2901
NPI assigned
Nov 12, 2012
Last updated
Jun 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DALLAS MENNONITE RETIREMENT COMMUNITY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Mrs. Joy A Haverkost
Title
Director of Business Services
Phone
(503) 391-7549

Specialties & licenses 1

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

Addresses

Primary practice location

377 NW Jasper St
Dallas, OR 97338-1279

Mailing address

377 NW Jasper St
Dallas, OR 97338-1279
Phone (503) 623-5581

Other identifiers 1

IdentifierTypeStateIssuer
500653791MedicaidOR

Other names 1

  • Dallas Retirement Village Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130308000019 OR Part A Provider - Skilled Nursing Facility 0042465551 Practice locations: Dallas, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902140171. Details of each certification follow.

Skilled nursing facility certification: CCN 385207

Legal name
DALLAS HEALTH CARE CENTER L L C
Doing business as
DALLAS RETIREMENT VILLAGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 12, 1989
Last certification
Dec 6, 2024
Beds
121
Ownership / control type
Individual
Organization structure
LLCNon-profit
Incorporated
Jun 13, 2002 in OR
Enrollment address
377 NW Jasper St
Dallas, OR 97338-1279
Nursing home name
DALLAS RETIREMENT VILLAGE HEALTH CENTER
Affiliated entity
LIFE CARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Dallas Retirement Village Health CenterCCN 385207 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Sep 12, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12197.4 residents per day on average
Chain
Life Care Services43 facilities in the chain

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
38D0687093Dallas Retirement Village377 NW Jasper St Attn Mary Driscoll, Dallas, OR 97338Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dallas Health Care Center L L C2 organizations share this tax ID, including this one
Part of
Dallas Nursing Home

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
John W Buckingham Individual Corporate DirectorBoard Member Jan 1, 2022
Robert J Ottaway Individual Corporate OfficerPresident Jan 1, 2020
Corporate DirectorBoard Member Jan 1, 2022
Lument Real Estate Capital LLC Organization, Dallas, TX LLC 5% Or Greater Mortgage Interest Apr 19, 2003 51%
5% Or Greater Security Interest Apr 19, 2003 51%
Debra Pauls Individual Corporate DirectorBoard Member Mar 26, 2020
Joseph Newman Individual Corporate DirectorBoard Member Jan 1, 2025
David K Parrett Individual Operational/Managerial ControlExecutive Director Jan 1, 2025
Adp of the SNF Jan 1, 2025
Life Care Services LLC Organization, Des Moines, IA LLC, Management services company, For-profit Operational/Managerial Control Oct 28, 2012
Adp of the SNF Jun 16, 2025
Debra McCleery Individual Corporate DirectorBoard Member Jan 1, 2024
Yolanda B Suarez Individual Operational/Managerial Control Feb 1, 2026
Adp of the SNF Feb 1, 2026
Michael Fast Individual Corporate DirectorBoard Member Jan 1, 2024
Stefanie Sanborn Individual Operational/Managerial ControlAdministrator Jan 1, 2025
Adp of the SNF Jan 1, 2025
Dallas Mennonite Retirement Community, Inc. Organization, Dallas, OR Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Susan E Humphrey Individual Corporate DirectorSecretary & Board Member Jan 1, 2022
Nita Vellody Individual Operational/Managerial Control Aug 1, 2020
Adp of the SNF Aug 1, 2020
Nancy J Adams Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 57

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

View all 57

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1352678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1902140171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 NW JASPER ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381279",
            "telephone_number": "503-623-5581",
            "fax_number": "503-623-2901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 NW JASPER ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381279",
            "telephone_number": "503-623-5581",
            "fax_number": "503-623-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS HEALTH CARE CENTER L L C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DALLAS MENNONITE RETIREMENT COMMUNITY, INC.",
        "enumeration_date": "2012-11-12",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "HAVERKOST",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS SERVICES",
        "authorized_official_telephone_number": "503-391-7549",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500653791",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dallas Retirement Village Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dallas, OR

Sources for this page

Verify at the official NPI Registry.