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Organization
SAPPHIRE AT GRACELEN LLC
Active
Organization
SAPPHIRE AT GRACELEN LLC
Active
Other names
Gracelen Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN MICHAEL RICKER (MANAGING MEMBER)
(503) 887-7395
Entity
Organization
Contact information
Practice address
10948 SE BOISE ST, PORTLAND, OR 97266-2202
(503) 760-1727
Mailing address
305 NE 102ND AVE STE 250, PORTLAND, OR 97220-4170
(503) 887-7395
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500829852
—
OR
Enumeration date
11/20/2023
Last updated
11/28/2025
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