Healthcare Provider Details

I. General information

NPI: 1285672907
Provider Name (Legal Business Name): TOUCHMARK AT MOUNT BACHELOR VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19800 SW TOUCHMARK WAY
BEND OR
97702-1942
US

IV. Provider business mailing address

5150 SW GRIFFITH DR
BEAVERTON OR
97005-2935
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-7071
  • Fax: 541-312-7080
Mailing address:
  • Phone: 503-646-5186
  • Fax: 503-644-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number131384
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BRIAN E PRYOR
Title or Position: EVP OPERATIONS
Credential:
Phone: 503-646-5186