Provider Demographics
NPI:1104576370
Name:VOP DERIAN PLACE, LLC
Entity type:Organization
Organization Name:VOP DERIAN PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE AND LICENSING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-998-5810
Mailing Address - Street 1:5101 NE 82ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6343
Mailing Address - Country:US
Mailing Address - Phone:360-254-9442
Mailing Address - Fax:360-254-1770
Practice Address - Street 1:1801 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5049
Practice Address - Country:US
Practice Address - Phone:605-846-6200
Practice Address - Fax:605-725-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDTBDMedicaid