1417118555 NPI number — SPRING VALLEY LIMITED PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417118555 NPI number — SPRING VALLEY LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRING VALLEY LIMITED PARTNERSHIP
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:
1417118555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HAWTHORNE AVE SE STE A140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97301-5092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-588-2725
Provider Business Mailing Address Fax Number:
503-588-8653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 HARLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-744-2116
Provider Business Practice Location Address Fax Number:
541-744-0103
Provider Enumeration Date:
06/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOSS
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR OF RISK MANAGEMENT
Authorized Official Telephone Number:
503-588-2725

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  1928687690 , 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)

  • Identifier: 555099 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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