| NPI | 1295494110 |
|---|---|
| Doing Business As | SOUTH GROVE LODGE SENIOR LIVING |
| Entity Type | Organization |
| Authorized Contact | TERRI LYNN BAKER Finance And Licensing Coordinator 503-998-5810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2021-12-08 |