Healthcare Provider Details

I. General information

NPI: 1316885189
Provider Name (Legal Business Name): PLCV III OPERATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SW ANIQUE LN
GRANTS PASS OR
97526-5416
US

IV. Provider business mailing address

25260 SW PARKWAY AVE STE B
WILSONVILLE OR
97070-6627
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-4376
  • Fax:
Mailing address:
  • Phone: 503-826-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

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