Basic Information
| Provider Information | |||||||||
| NPI: | 1629381454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AIDAN SENIOR LIVING AT REEDWOOD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 COMMERCIAL ST NE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035884428 | ||||||||
| FaxNumber: | 5035881087 | ||||||||
| Practice Location | |||||||||
| Address1: | 3540 SE FRANCIS ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032325767 | ||||||||
| FaxNumber: | 5032344162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2010 | ||||||||
| LastUpdateDate: | 07/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5035884428 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.