1255367017 NPI number — TOUCHMARK LIVING CENTERS, INC

Table of content: SHELBY TATE SHINN RN (NPI 1699592659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255367017 NPI number — TOUCHMARK LIVING CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOUCHMARK LIVING CENTERS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255367017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 SW GRIFFITH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97005-2935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-646-5186
Provider Business Mailing Address Fax Number:
503-644-3568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97504-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-774-4175
Provider Business Practice Location Address Fax Number:
541-774-4174
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRYOR
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
VP OPERATIONS
Authorized Official Telephone Number:
503-646-5186

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  13-1362 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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