Provider Demographics
NPI:1194310672
Name:SAPPHIRE AT MORAN VISTA, LLC
Entity type:Organization
Organization Name:SAPPHIRE AT MORAN VISTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-887-7395
Mailing Address - Street 1:127 NE 102ND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4152
Mailing Address - Country:US
Mailing Address - Phone:503-887-7395
Mailing Address - Fax:
Practice Address - Street 1:3319 E 57TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7022
Practice Address - Country:US
Practice Address - Phone:509-443-1944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility