Healthcare Provider Details

I. General information

NPI: 1568211662
Provider Name (Legal Business Name): CHEHALEM SNF HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E FULTON ST
NEWBERG OR
97132-1806
US

IV. Provider business mailing address

262 N UNIVERSITY AVE
FARMINGTON UT
84025-2975
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-2108
  • Fax:
Mailing address:
  • Phone: 801-447-9829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSHUA JERGENSEN
Title or Position: PRESIDENT
Credential:
Phone: 801-447-9829