1/2/2015 PROVIDER NAME ADDRESS NAME OF HOME RESIDENT MANAGER TELEPHONE Resident Manager: Sue Wilcox Text77: Astoria Telephone: (503) 468-0258 OR 97103 Croos, Soosaiappu Ave Resident Manager: Text77: Astoria Telephone: (503) 338-6922 Resident Manager: Text77: Gearhart Telephone: (503) 717-5590 Earley, Heather Address: 87943 Hwy 202 Resident Manager: Text77: Astoria Telephone: (503) 325-2438 OR 97103 Resident Manager: Telephone: (503) 738-6714 Johanson, Nellie Rd Resident Manager: Text77: Astoria Telephone: (503) 458-7400 Resident Manager: Text77: Astoria Telephone: (503) 325-5731 Kancharla, Joseph Address: 4809 Cedar St. Resident Manager: Text77: Astoria Telephone: (503) 325-4209 Resident Manager: Text77: Astoria Telephone: (503) 325-5312 Ca5 Yes Smoking: No 1 DC: CLASS 3 MEDICAID Yes Ca5 Yes Smoking: Outside DC: CLASS 1 MEDICAID Yes Prov Number: 522348 Ca5 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Ca4 Yes Smoking: Outside DC: CLASS 3 MEDICAID Yes Ca2 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Ca3 Yes Smoking: No DC: Kancharla, William Ave Resident Manager: Text77: Astoria Telephone: (503) 741-3021 CLASS 2 MEDICAID Yes Prov Number: 521681 Ca5 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Prov Number: 550785 Winter Lite AFH Address: 3080 Grand OR 97103 2 MEDICAID Yes 1 Alder Home Kancharla, Kruparao Address: 4777 Cedar St. OR 97103 CLASS Prov Number: 517186 Kahle, Brent & Renee Address: 418 Pleasant Avenue OR 97103 Smoking: Outside Prov Number: 520129 Address: 92496 Abbott OR 97103 DC: Prov Number: 517784 Text77: Gearhart OR 97103 Ca5 Yes Heathers Country Haven Graber, Joyce Address: 501 Railroad Ave OR 97138 PROVIDER # CLASS CONTRACT Prov Number: 523610 Denhart, Patricia Address: 88755 Mallard Court OR 97138 DC CAPACITY RB SMOKING Prov Number: 505682 Address: 1164 Irving OR 97103 WHEELCHAIR Prov Number: 523698 Bolles, Melanie Address: 91371 Lewis & Clark Rd 1/2/2015 16 ADULT FOSTER HOMES: Clatsop Ca5 Yes DC: Smoking: Outside CLASS 2 MEDICAID Yes 1 Prov Number: 524121 Grand Adult Foster Home LLC Yes Ca5 DC: (p) = Pending; DC = DayCare; RB = Room and Board Smoking: Outside CLASS 2 MEDICAID Yes Clatsop Page 1 of 2 Public disclosure files on Adult Foster Homes are available for review. Contact the foster home licensing staff (503-304-3400) for an appointment. Master Lists are available in alternate format. PROVIDER NAME ADDRESS NAME OF HOME RESIDENT MANAGER TELEPHONE Kancharla, Manivao, Kanc Address: 4795 Cedar St. Resident Manager: Text77: Astoria Telephone: (503) 325-5312 OR 97103 Resident Manager: Text77: Warrenton Telephone: (503) 861-8388 Resident Manager: Text77: Astoria Telephone: (503) 325-5634 Resident AnnetteManager: Llanera Text77: Astoria Telephone: (503) 325-6206 Stark, Alesha Address: 1145 Queen Street Resident Manager: Text77: Seaside Telephone: (503) 738-4237 Heart's Care, LLC Resident Manager: Dana Davidson Text77: Hammond Telephone: (503) 861-2518 1/2/2015 DC: CLASS 2 MEDICAID Yes Prov Number: 524502 Ca5 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Ca4 Yes DC: Smoking: Yes CLASS 3 MEDICAID Yes 1 Ca5 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Prov Number: 523542 Comfort House Waddell, Chandra Address: 296 Tyee St OR 97121 Smoking: Outside Prov Number: 514346 Pichika, Jayalakshmi Address: 3579 Harrison Ave OR 97138 Ca5 Yes Prov Number: 510143 Nichols, Teresa Ln OR 97103 PROVIDER # CLASS CONTRACT Prov Number: 518389 Birch Court AFH Address: 37671 Timber OR 97103 DC CAPACITY RB SMOKING Kancharlas AFH LLC Nakka,Chandini, Nakka, Vi Address: 52 NW Birch Ct OR 97146 WHEELCHAIR Ca4 Yes Smoking: Outside DC: CLASS 2 MEDICAID Yes Prov Number: 516987 Ca5 Yes DC: (p) = Pending; DC = DayCare; RB = Room and Board Smoking: Outside CLASS 2 MEDICAID Yes Clatsop Page 2 of 2 Public disclosure files on Adult Foster Homes are available for review. Contact the foster home licensing staff (503-304-3400) for an appointment. Master Lists are available in alternate format.
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