MEADOWLAND ADULT FOSTER HOME LLC (NPI# 1508215252) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508215252 |
| Entity Type | Organization |
| Organization Name | MEADOWLAND ADULT FOSTER HOME LLC |
| Practice Address |
706 Meadow Ave Tillamook OR 97141-2844 |
| Practice Telephone | 5033542523 |
| Practice Fax Number | 5033545116 |
| Mailing Telephone | 5033542523 |
| Mailing Fax Number | 5033545116 |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-24 |
| Authorized Official Name | MR. SUJAY KUMAR NAKKA (OWNER) |
| Authorized Official Telephone | 5033542523 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
500697789 | OR | Nursing & Custodial Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MEADOWLAND ADULT FOSTER HOME LLC | 706 Meadow Ave, Tillamook, OR 97141 |
| Street Address |
706 MEADOW AVE |
| City | TILLAMOOK |
| State | OR |
| Zip Code | 97141-2844 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659833341 | Cory Baird | Case Manager/Care Coordinator | 706 Meadow Ave, Tillamook, OR 97141-2844 | 2019-04-02 |
| 1932654118 | Sujay Nakka | Case Manager/Care Coordinator | 706 Meadow Ave, Tillamook, OR 97141-2844 | 2016-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265062517 | Anna Cobarrubia | Health Educator | Tillamook Family Ymca, 610 Stillwell Ave., Tillamook, OR 97141 | 2020-01-24 |
| 1164066510 | Barbara Kay Shipman | Technician | 515 Laurel Ave., Tillamook, OR 97141 | 2019-10-29 |
| 1457848608 | Arnadene Vanebo | Dietitian, Registered | 801 Pacific Avenue, Tillamook, OR 97141 | 2018-04-13 |
| 1336339647 | Shirley Arneson | Nurse Practitioner | 1011 Third St, Bay Ocean Medical, PC, Tillamook, OR 97141 | 2007-08-01 |
| 1467595413 | County of Tillamook | Local Education Agency (LEA) | 6825 Officers Row, Tillamook, OR 97141 | 2007-02-15 |
| 1801998190 | Dave R Bizeau | Dentist | 2103 10th Street, Tillamook, OR 97141 | 2006-09-05 |
| 1134166481 | Cassandra Wolfson | Social Worker | 2507 Main Avenue N, Suite B, Tillamook, OR 97141 | 2006-06-02 |
| 1578535175 | Paul C Welch | Obstetrics & Gynecology | 1000 3rd Street, Tillamook, OR 97141 | 2006-02-07 |
| 1023514627 | Mehrdad Hairani | Dentist | 1010 Main Ave, Tillamook, OR 97141 | 2018-04-03 |
| 1467979609 | Karen Sheelar | Counselor | 801 Pacific Ave, Tillamook, OR 97141 | 2017-08-28 |
| Find all providers in zip 97141 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881295921 | Devona Lynn Shepard | Assisted Living Facility | 1030 Sw 8th Ave, Ontario, OR 97914-3316 | 2020-11-05 |
| 1619592193 | Concepts In Community Living, Inc. | Assisted Living Facility | 1337 Sw Washington St, Portland, OR 97205-2328 | 2020-06-10 |
| 1598313199 | Bernadette Frances Smith | Assisted Living Facility | 92158 Cape Arago Hwy, Coos Bay, OR 97420-8743 | 2019-08-28 |
| 1376081810 | Amazing Grace Care Homes, Incesident | Assisted Living Facility | 1205 Barnes Ave Se, Salem, OR 97306-1539 | 2017-02-04 |
| 1477090504 | Michelle Hasson | Assisted Living Facility | 4548 Sw 191st Ave, Aloha, OR 97078-2425 | 2017-01-26 |
| 1447636071 | Community Services, Inc. | Assisted Living Facility | 14215 Nw Science Park Dr, Portland, OR 97229-5416 | 2015-08-05 |
| 1346589728 | Nursefinders | Assisted Living Facility | 5510 Nw 146th Ave, Portland, OR 97229-9263 | 2013-02-05 |
| 1437317229 | Ocean Park | Assisted Living Facility | 984 Parkview Dr, Brookings, OR 97415-9116 | 2008-05-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.