Healthcare Provider Details

I. General information

NPI: 1396229787
Provider Name (Legal Business Name): BISHOP SUGARLAND RIDGE LESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 SUGARLAND DR
SHERIDAN WY
82801-5721
US

IV. Provider business mailing address

5885 MEADOWS RD STE 500
LAKE OSWEGO OR
97035-8646
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-5575
  • Fax: 307-674-8070
Mailing address:
  • Phone: 971-254-1368
  • 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: TRACEY GAMBLE
Title or Position: VICE PRESIDENT
Credential:
Phone: 212-472-4067