MEDICARE: ROSEMONT AT CLEARLAKE

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

General Provider Information

NPI Number	:	1578781084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEMONT AT CLEARLAKE

Provider Business Mailing Address
First Line	:	PO BOX 3006
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-0006
Country	:	US
Telephone Number	:	503-485-8697
Fax Number	:	503-485-1279

Provider Business Practice Location Address
First Line	:	14101 BAY POINTE CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8107
Country	:	US
Telephone Number	:	281-461-7600
Fax Number	:	503-485-1279

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	JON HARDER
Credential	:
Telephone Number	:	503-485-8697

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	08/22/2020

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