1578886834 NPI number — AIDAN SENIOR LIVING AT REEDSPORT INC.

Table of content: (NPI 1578886834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578886834 NPI number — AIDAN SENIOR LIVING AT REEDSPORT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIDAN SENIOR LIVING AT REEDSPORT 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:
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:
1578886834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 COMMERCIAL ST NE STE 11
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:
97301-3486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-588-4428
Provider Business Mailing Address Fax Number:
503-588-1087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 RANCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97467-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-271-2171
Provider Business Practice Location Address Fax Number:
541-271-2941
Provider Enumeration Date:
03/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TROY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-588-4428

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500621067 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com