Healthcare Provider Details

I. General information

NPI: 1386631422
Provider Name (Legal Business Name): CML INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 WEATHERS ST NE
SALEM OR
97301-1933
US

IV. Provider business mailing address

4254 WEATHERS ST NE
SALEM OR
97301-1933
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-4602
  • Fax: 503-585-6002
Mailing address:
  • Phone: 503-585-4602
  • Fax: 503-585-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number805788
License Number StateOR

VIII. Authorized Official

Name: MS. LORI LASSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 503-585-4602