Basic Information
| Provider Information | |||||||||
| NPI: | 1740959154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLTOWER TENANT GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7420 SW BRIDGEPORT RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035974906 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8525 URBANDALE AVE | ||||||||
| Address2: | |||||||||
| City: | URBANDALE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503224108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153310970 | ||||||||
| FaxNumber: | 5153318935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2021 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | RODERICK | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5034431818 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WELLTOWER TENANT GROUP LLC | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.