Basic Information
| Provider Information | |||||||||
| NPI: | 1407499155 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CSL - MONMOUTH I, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 E 10TH AVE STE 104 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974013273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416363460 | ||||||||
| FaxNumber: | 5416363460 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 GWINN ST E | ||||||||
| Address2: | |||||||||
| City: | MONMOUTH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973611571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038386850 | ||||||||
| FaxNumber: | 5038386443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2019 | ||||||||
| LastUpdateDate: | 10/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | FORSYTH | ||||||||
| AuthorizedOfficialFirstName: | WILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5416363460 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMPASS SENIOR LIVING LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.