Healthcare Provider Details

I. General information

NPI: 1114849262
Provider Name (Legal Business Name): SALEM OF OLYMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 CENTER ST NE
SALEM OR
97301-4277
US

IV. Provider business mailing address

1625 CENTER ST NE
SALEM OR
97301-4277
US

V. Phone/Fax

Practice location:
  • Phone: 503-967-6312
  • Fax:
Mailing address:
  • Phone: 208-401-0960
  • 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: OWEN HAMMOND
Title or Position: PRESIDENT
Credential:
Phone: 208-401-9600