Basic Information
| Provider Information | |||||||||
| NPI: | 1720604150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST LINN CARE CENTER OPERATING COMPANY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 BLANKENSHIP RD STE 475 | ||||||||
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| City: | WEST LINN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970684248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033446065 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2330 DEBOK RD | ||||||||
| Address2: | |||||||||
| City: | WEST LINN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970683998 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036550474 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2020 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALDROFF | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5033446065 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311500000X | Y | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |
No ID Information.