Healthcare Provider Details

I. General information

NPI: 1417957655
Provider Name (Legal Business Name): MENNONITE HOME OF ALBANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 COLUMBUS ST SE
ALBANY OR
97322-7136
US

IV. Provider business mailing address

5353 COLUMBUS ST SE
ALBANY OR
97322-7136
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-7232
  • Fax: 541-917-1399
Mailing address:
  • Phone: 541-928-7232
  • Fax: 541-917-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateOR

VIII. Authorized Official

Name: MR. CHESTER W. PATTERSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA, NHA
Phone: 541-928-7232