Healthcare Provider Details

I. General information

NPI: 1720207186
Provider Name (Legal Business Name): BD REDMOND IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SW RESERVOIR RD
REDMOND OR
97756-9481
US

IV. Provider business mailing address

3326 160TH AVE SE SUITE 120
BELLEVUE WA
98008-6418
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-5066
  • Fax: 541-548-3752
Mailing address:
  • Phone: 425-392-4066
  • Fax: 425-623-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1560569881
License Number StateOR

VIII. Authorized Official

Name: MR. DOUG DEVORE
Title or Position: CFO
Credential:
Phone: 425-392-4066