Blue Diamond Estates

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

BLUE DIAMOND ESTATES

Practice address

87326 McTimmons LN
Bandon, OR 97411-8285

Phone

(541) 217-4006

Fax

(541) 347-7555

NPI assigned

Jan 5, 2021

Last updated

Jan 5, 2021By 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

Mary Johnson

Title

Qmha

Phone

(541) 751-5040

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1962090951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87326 MCTIMMONS LN",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974118285",
            "telephone_number": "541-217-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87326 MCTIMMONS LN",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974118285",
            "telephone_number": "541-217-4006",
            "fax_number": "541-347-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE DIAMOND ESTATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "QMHA",
        "authorized_official_telephone_number": "541-751-5040"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "527511",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Bandon",
            "affiliation": "N",
            "address_1": "87326 McTimmons Ln",
            "city": "Bandon",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974118285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bandon Pharmacy
• Bandon Senior Living LLC (Pacific View Senior Living LLC)
• Janet M Bates, M.D.
• Kenneth Robert Bates, MD
• Rosemary Winifred Bean
• Linda M Bono, FNP
• Christina Marie Brakebill, RN, FNP-BC
• Stephen Hutchins Brown, ND
• Alexandra J Campbell, MSW
• Muthalib M Cassim, MD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Bandon, OR
• Providers in Bandon, OR by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.