Healthcare Provider Details

I. General information

NPI: 1982513263
Provider Name (Legal Business Name): LEBANON OF OLYMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 12TH ST
LEBANON OR
97355-1201
US

IV. Provider business mailing address

1401 S 12TH ST
LEBANON OR
97355-1201
US

V. Phone/Fax

Practice location:
  • Phone: 541-259-1779
  • Fax:
Mailing address:
  • Phone: 208-401-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: OWEN HAMMOND
Title or Position: PRESIDENT
Credential:
Phone: 208-401-9600