Basic Information
| Provider Information | |||||||||
| NPI: | 1104818202 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SNR INC | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | ROYALE GARDENS HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2075 NW HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975263310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414768891 | ||||||||
| FaxNumber: | 5414762679 | ||||||||
| Practice Location | |||||||||
| Address1: | 2075 NW HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975263310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414768891 | ||||||||
| FaxNumber: | 5414762679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 10/08/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KRAUSS | ||||||||
| AuthorizedOfficialFirstName: | TAMI | ||||||||
| AuthorizedOfficialMiddleName: | LYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | BOOKKEEPER | ||||||||
| AuthorizedOfficialTelephone: | 5419562288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | OR | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 314000000X | 385148 | OR | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 800214 | 05 | OR | MEDICAID |