Basic Information
| Provider Information | |||||||||
| NPI: | 1942850789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCP ESL PORTLAND OR OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | SELLWOOD, C/O ECLIPSE SENIOR LIVING, ATTN: LICENSING | ||||||||
| Address2: | 5885 MEADOWS RD., #500 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970358646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712134234 | ||||||||
| FaxNumber: | 8662469514 | ||||||||
| Practice Location | |||||||||
| Address1: | 8517 SE 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972027347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035424800 | ||||||||
| FaxNumber: | 5035424801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | FLEMING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CONROLLER | ||||||||
| AuthorizedOfficialTelephone: | 9713373922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.