Healthcare Provider Details

I. General information

NPI: 1407833924
Provider Name (Legal Business Name): TERRACE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8607 SE CAUSEY AVE
HAPPY VALLEY OR
97086-7579
US

IV. Provider business mailing address

8607 SE CAUSEY AVE
HAPPY VALLEY OR
97086-7579
US

V. Phone/Fax

Practice location:
  • Phone: 503-654-4500
  • Fax: 503-786-1232
Mailing address:
  • Phone: 503-654-4500
  • Fax: 503-786-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number385236
License Number StateOR

VIII. Authorized Official

Name: DR. RUTH KOBEL
Title or Position: CONTROLLER
Credential:
Phone: 503-652-0750