Healthcare Provider Details

I. General information

NPI: 1366171050
Provider Name (Legal Business Name): MRS. LILIYA KORIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16693 SE RIVER RD
MILWAUKIE OR
97267-4505
US

IV. Provider business mailing address

16693 SE RIVER RD
MILWAUKIE OR
97267-4505
US

V. Phone/Fax

Practice location:
  • Phone: 360-616-1300
  • Fax:
Mailing address:
  • Phone: 360-616-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number519238
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: