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PROVIDENCE ELDERPLACE
NPI 1750837597
Assisted Living Facility in Portland, OR

Active since August 31, 2016CLIA 38D0973869 · Waiver
16430 NE HOYT ST, PORTLAND, OR 97230(503) 875-5172 Get Directions Write a Review

NPPES record last updated: August 31, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Providence Elderplace NPPES

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

PROVIDENCE ELDERPLACE (NPI 1750837597) is a healthcare organization registered as an assisted living facility in Portland, Oregon and active in the NPI registry since August 2016. The organization holds a CLIA Waiver certificate valid through May 21, 2028 and lists Lomingo M Andrews, Lpn, as its authorized official.

NPPES Registry Identity

NPI1750837597
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NamePROVIDENCE ELDERPLACE
Location Address16430 NE HOYT STPortland, OR 97230
Mailing Address16430 Ne Hoyt StPortland, OR 97230-5846 · (503) 875-5172
Phone(503) 875-5172
Organization SubpartYesParent: Providence Health Systems
Authorized OfficialLomingo M AndrewsLpn · (503) 546-9292
Enumeration DateAugust 31, 2016
✔ NPI 1750837597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in OR · 201130602LPN
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.
16430 NE HOYT ST, Portland, OR 97230
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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 38D0973869

Providence Elderplace · Portland, OR
Active · expires May 21, 2028
CLIA Number38D0973869
Laboratory TypeElderplace Health And Soc
Certificate Effective DateMay 22, 2026
Certificate Expiration DateMay 21, 2028
Laboratory DirectorPamela Bosa
Laboratory Phone(503) 215-6556
Laboratory LocationProvidence Elderplace13007 NE Glisan St, Portland, OR 97230
CLIA data matches this NPI record on: Name
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 Providence Elderplace's NPI number?

The NPI number for Providence Elderplace is 1750837597. It was assigned to this organization in the NPPES registry on August 31, 2016.

Where is Providence Elderplace located?

Providence Elderplace is located at 16430 NE Hoyt St, Portland, OR 97230. The listed phone number is (503) 875-5172.

What is Providence Elderplace's specialty?

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

Does Providence Elderplace hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 38D0973869) is associated with this NPI, valid through May 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Providence Elderplace was last updated on August 31, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.