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SENIOR HAVEN LLC
NPI 1700408010
Assisted Living Facility in Portland, OR

Active since May 08, 2020CLIA 38D2194426 · Waiver
12140 SE FOSTER RD, PORTLAND, OR 97266(971) 271-8975 Get Directions Write a Review

NPPES record last updated: May 8, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Senior Haven Llc NPPES

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

SENIOR HAVEN LLC (NPI 1700408010), doing business as Senior Haven Rcf, is a healthcare organization registered as an assisted living facility in Portland, Oregon and active in the NPI registry since May 2020. The organization holds a CLIA Waiver certificate valid through September 29, 2026 and lists Robert Austin Evans, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1700408010
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSENIOR HAVEN LLC
Location Address12140 SE FOSTER RDPortland, OR 97266-4043
Mailing AddressPo Box 1410Bend, OR 97709-1410 · (541) 317-9188 · Fax (541) 389-3710
Phone(971) 271-8975
Organization SubpartNo
Authorized OfficialRobert Austin EvansManaging Member · (541) 317-9188
Enumeration DateMay 8, 2020
NPPES CertifiedMay 8, 2020
✔ NPI 1700408010 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.

12140 SE FOSTER RD, Portland, OR 97266
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Other Names 1

Doing Business AsSenior Haven Rcf

Other Identifiers 1

Medicaid164402OR

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 38D2194426

Senior Haven Rcf · Portland, OR
Active · expires Sep 29, 2026
CLIA Number38D2194426
Laboratory TypeResidential Care Facility
Certificate Effective DateSeptember 30, 2024
Certificate Expiration DateSeptember 29, 2026
Laboratory DirectorOlga Maximov
Laboratory Phone(971) 271-8975
Laboratory LocationSenior Haven Rcf12140 SE Foster Rd, Portland, OR 97266
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Senior Haven LLC's NPI number?

The NPI number for Senior Haven LLC is 1700408010. It was assigned to this organization in the NPPES registry on May 8, 2020. The provider is doing business as Senior Haven RCF.

Where is Senior Haven LLC located?

Senior Haven LLC is located at 12140 SE Foster Rd, Portland, OR 97266. The listed phone number is (971) 271-8975.

What is Senior Haven LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Senior Haven LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D2194426) is associated with this NPI, valid through September 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Senior Haven LLC was last updated on May 8, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.