Healthcare Provider Details

I. General information

NPI: 1861837023
Provider Name (Legal Business Name): GREEN VALLEY REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 ADKINS ST
EUGENE OR
97401-5003
US

IV. Provider business mailing address

1735 ADKINS ST
EUGENE OR
97401-5003
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5032
  • Fax:
Mailing address:
  • Phone: 541-683-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number201130560LPN
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KACI MCKEE
Title or Position: DNS
Credential: RN
Phone: 541-683-5032