Basic Information
| Provider Information | |||||||||
| NPI: | 1568617694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHANGRI-LA CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4080 REED RD SE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973021100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035811732 | ||||||||
| FaxNumber: | 5035815638 | ||||||||
| Practice Location | |||||||||
| Address1: | 4080 REED RD SE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973021100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035811732 | ||||||||
| FaxNumber: | 5035815638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | WINKLE | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | LENAY | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5035811732 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.