MEDICARE: RICHLAND SPECIALITY CARE LLC QUAIL HOLLOW MEMORY CARE COMMUNITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	BH 1786	WA

General Provider Information

NPI Number	:	1548304082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHLAND SPECIALITY CARE LLC QUAIL HOLLOW MEMORY CARE COMMUNITY

Provider Business Mailing Address
First Line	:	PO BOX 3006
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-0006
Country	:	US
Telephone Number	:	503-485-4600
Fax Number	:	503-485-1495

Provider Business Practice Location Address
First Line	:	221 TORBETT ST
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2667
Country	:	US
Telephone Number	:	509-943-5353
Fax Number	:	503-485-1495

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. JON HARDER
Credential	:
Telephone Number	:	503-486-4600

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	08/22/2020

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