Healthcare Provider Details

I. General information

NPI: 1023486883
Provider Name (Legal Business Name): BAYCREST ESTATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 SHERIDAN AVE
NORTH BEND OR
97459-2834
US

IV. Provider business mailing address

4676 COMMERCIAL ST SE # 958
SALEM OR
97302-1902
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-5141
  • Fax:
Mailing address:
  • Phone: 503-689-1808
  • Fax: 503-585-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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