Healthcare Provider Details

I. General information

NPI: 1609486828
Provider Name (Legal Business Name): NORTHRIDGE SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 E BARNETT RD
MEDFORD OR
97504-8397
US

IV. Provider business mailing address

2979 E BARNETT RD
MEDFORD OR
97504-8397
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-6943
  • Fax:
Mailing address:
  • Phone: 541-779-6943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEMORY AMBER SALLIOTTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-779-6943