Healthcare Provider Details

I. General information

NPI: 1205452638
Provider Name (Legal Business Name): WMC OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 N BOONES FERRY RD
WOODBURN OR
97071-9627
US

IV. Provider business mailing address

1800 BLANKENSHIP RD STE 475
WEST LINN OR
97068-4248
US

V. Phone/Fax

Practice location:
  • Phone: 503-980-9990
  • Fax:
Mailing address:
  • Phone: 503-344-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: TERESA WALDROFF
Title or Position: MANAGER
Credential:
Phone: 33-446-0655