Healthcare Provider Details

I. General information

NPI: 1518245893
Provider Name (Legal Business Name): LAUREL COURT OF EUGENE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 LONE OAK WAY
EUGENE OR
97404-2547
US

IV. Provider business mailing address

1818 WESTLAKE AVE N STE 310
SEATTLE WA
98109-2707
US

V. Phone/Fax

Practice location:
  • Phone: 541-607-5025
  • Fax:
Mailing address:
  • Phone: 206-441-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number1521694361
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier522713
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. DENIS R BRYANT
Title or Position: MANAGING MEMBER
Credential:
Phone: 206-441-1770