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RUSSELLVILLE PARK
NPI 1164845921
Assisted Living Facility in Portland, OR

Active since January 30, 2014CLIA 38D2179837 · Waiver
23 SE 103RD AVE, PORTLAND, OR 97216(503) 254-5900 Get Directions Write a Review

NPPES record last updated: January 30, 2014. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Russellville Park NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RUSSELLVILLE PARK (NPI 1164845921) is a healthcare organization registered as an assisted living facility in Portland, Oregon and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through March 2, 2028 and lists Rayn Rasar, Vp Operations, as its authorized official.

NPPES Registry Identity

NPI1164845921
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameRUSSELLVILLE III LLC
Location Address23 SE 103RD AVEPortland, OR 97216
Mailing Address23 Se 103rd AvePortland, OR 97216 · (503) 254-5900 · Fax (503) 255-7098
Phone(503) 254-5900
Organization SubpartNo
Authorized OfficialRayn RasarVp Operations · (206) 436-7827
Enumeration DateJanuary 30, 2014
✔ NPI 1164845921 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

23 SE 103RD AVE, Portland, OR 97216
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Other Names 1

Doing Business AsRussellville Park

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 38D2179837

Russellville Park · Portland, OR
Active · expires Mar 2, 2028
CLIA Number38D2179837
Laboratory TypeAssisted Living Facility
Certificate Effective DateMarch 3, 2026
Certificate Expiration DateMarch 2, 2028
Laboratory DirectorSara Albers
Laboratory Phone(503) 254-5900
Laboratory LocationRussellville Park20 SE 103rd Avenue, Portland, OR 97216
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions

What is RUSSELLVILLE III LLC's NPI number?

The NPI number assigned to this healthcare provider is 1164845921, enumerated as an "organization" on January 30, 2014.

Where is the provider located?

The provider is located at 23 SE 103RD AVE PORTLAND, OR 97216 and the phone number is (503) 254-5900.

What is the provider's specialty?

Assisted Living Facility with taxonomy code 310400000X.