Healthcare Provider Details

I. General information

NPI: 1558580993
Provider Name (Legal Business Name): BD BEND III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SE WILSON AVE
BEND OR
97702-1714
US

IV. Provider business mailing address

119 SE WILSON AVE
BEND OR
97702-1714
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-7161
  • Fax:
Mailing address:
  • Phone: 541-382-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG DEVORE
Title or Position: CFO
Credential:
Phone: 425-392-4066