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General NPI Number Information
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NPI Number | 1003020686
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Entity Type | Organization
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Legal Business Name | HILLSIDE SENIOR LIVING COMMUNITY, LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 NW HILLSIDE PARK WAY
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City | MCMINNVILLE
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State | OR
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Zip | 97128
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Country | US
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Telephone | 503-472-9534
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Fax | 503-883-7477
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Provider Business Mailing Address
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Address Line | 300 NW HILLSIDE PARK WAY
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City | MCMINNVILLE
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State | OR
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Zip | 97128
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Country | US
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Telephone | 503-472-9534
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Fax | 503-883-7477
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Authorized Official
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Title or Position | ADMINISTRATOR-CAMPUS DIRECTOR
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Name | MR. RENE DUMAS
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Credential |
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Telephone | 503-472-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1022025704
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License Number State | OR
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