- Enrollment id
- O20170517001243
- Enrollment state
- OR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1700319381
- Multiple npi flag
- N
- Ccn
- 385264
- Associate id
- 0042587388
- Organization name
- PORTLAND OF CASCADIA LLC
- Doing business as name
- SECORA REHABILITATION OF CASCADIA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SECORA REHABILITATION OF CASCADIA
- Affiliation entity name
- CASCADIA HEALTHCARE
- Affiliation entity id
- 118
- Address line 1
- 10435 SE CORA ST
- City
- PORTLAND
- State
- OR
- Zip code
- 972662331