Healthcare Provider Details

I. General information

NPI: 1841815842
Provider Name (Legal Business Name): TSL OAK LANE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 SW ROGUE RIVER AVE
GRANTS PASS OR
97526-2777
US

IV. Provider business mailing address

727 SW ROGUE RIVER AVE
GRANTS PASS OR
97526-2777
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-7727
  • Fax:
Mailing address:
  • Phone: 541-476-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PEARY D WOOD
Title or Position: MANAGER
Credential:
Phone: 503-719-5614