Provider Demographics
NPI:1104069954
Name:EAST CASCADE RETIREMENT COMMUNITY, LLC
Entity type:Organization
Organization Name:EAST CASCADE RETIREMENT COMMUNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:REMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-588-4428
Mailing Address - Street 1:8415 SW SENECA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-6403
Mailing Address - Country:US
Mailing Address - Phone:035-588-4428
Mailing Address - Fax:503-588-1087
Practice Address - Street 1:175 NE 16TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-2219
Practice Address - Country:US
Practice Address - Phone:541-475-2273
Practice Address - Fax:541-475-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNOT YET ASSIGNED314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500618826Medicaid