Healthcare Provider Details

I. General information

NPI: 1780159194
Provider Name (Legal Business Name): ARLETA SHERWOOD PARK OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 ARLETA AVE NE
KEIZER OR
97303-4758
US

IV. Provider business mailing address

31351 RANCHO VIEJO RD STE 102
SAN JUAN CAPO CA
92675-1857
US

V. Phone/Fax

Practice location:
  • Phone: 503-390-2271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: BRIAN NEWBERRY
Title or Position: CEO
Credential:
Phone: 801-899-5364