Healthcare Provider Details

I. General information

NPI: 1770108052
Provider Name (Legal Business Name): PENDLETON ALF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW 28TH DR
PENDLETON OR
97801-1871
US

IV. Provider business mailing address

15900 SE 82ND DR
CLACKAMAS OR
97015-9502
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-0666
  • Fax:
Mailing address:
  • Phone: 503-255-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER VERDIECK
Title or Position: EVP FINANCE & ADMINISTRATION
Credential:
Phone: 503-255-4647