Healthcare Provider Details

I. General information

NPI: 1477604924
Provider Name (Legal Business Name): CARE CENTERS MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 ASH ST
MYRTLE POINT OR
97458-1133
US

IV. Provider business mailing address

637 ASH ST
MYRTLE POINT OR
97458-1133
US

V. Phone/Fax

Practice location:
  • Phone: 541-572-2066
  • Fax: 541-572-5477
Mailing address:
  • Phone: 541-572-2066
  • Fax: 541-572-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0679037-8
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier800396
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. KENT EMRY
Title or Position: PRESIDENT
Credential:
Phone: 503-884-0895