Healthcare Provider Details

I. General information

NPI: 1346313012
Provider Name (Legal Business Name): MEADOW PARK HEALTH - ST. HELENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SHORE DRIVE
SAINT HELENS OR
97051-1199
US

IV. Provider business mailing address

3220 ROSEDALE ST NW STE 200
GIG HARBOR WA
98335-1837
US

V. Phone/Fax

Practice location:
  • Phone: 503-397-2713
  • Fax: 503-397-2669
Mailing address:
  • Phone:
  • 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: MR. DOV E. JACOBS
Title or Position: MANAGER
Credential:
Phone: 323-678-4426