Healthcare Provider Details

I. General information

NPI: 1679409023
Provider Name (Legal Business Name): WALLOWA LIVING OPERATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

IV. Provider business mailing address

605 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-5311
  • Fax:
Mailing address:
  • Phone: 541-426-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CARL MASON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 503-826-5190