Healthcare Provider Details

I. General information

NPI: 1033559349
Provider Name (Legal Business Name): MARQUIS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 U ST
SPRINGFIELD OR
97477-2155
US

IV. Provider business mailing address

25 U ST
SPRINGFIELD OR
97477-2155
US

V. Phone/Fax

Practice location:
  • Phone: 541-731-9917
  • Fax:
Mailing address:
  • Phone: 541-731-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number201330218LPN
License Number StateOR

VIII. Authorized Official

Name: EMMA GATCHET
Title or Position: HUMAN RESOURCES
Credential:
Phone: 541-736-2724