- Enrollment id
- O20070509000145
- Enrollment state
- OR
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1790909786
- Multiple npi flag
- N
- Ccn
- 385015
- Associate id
- 0547366452
- Organization name
- REGENCY GRESHAM NURSING & REHABILITATION CENTER, LLC
- Doing business as name
- REGENCY GRESHAM NURSING & REHABILITATION CENTER
- Incorporation date
- 2007-03-14
- Incorporation state
- WA
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- REGENCY GRESHAM NURSING & REHABILITATION CENTER
- Affiliation entity name
- REGENCY PACIFIC MANAGEMENT
- Affiliation entity id
- 442
- Address line 1
- 5905 SE POWELL VALLEY RD
- City
- GRESHAM
- State
- OR
- Zip code
- 970801919