| NPI | 1134495039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA LEE WALDROFF Manager 503-706-0878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: OR 1565662204) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2014-07-30 |