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General NPI Number Information
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NPI Number | 1023230166
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Entity Type | Organization
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Legal Business Name | UKIAH ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 1343 DORA ST
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City | UKAIA
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State | CA
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Zip | 95482-6542
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Country | US
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Telephone | 707-462-6212
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Fax | 503-485-1279
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Provider Business Mailing Address
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Address Line | PO BOX 3006
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City | SALEM
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State | OR
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Zip | 97302-0006
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Country | US
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Telephone | 503-375-9016
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Fax | 503-485-1279
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Authorized Official
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Title or Position | MANAGER
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Name | JON M HARDER
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Credential |
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Telephone | 503-375-9016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 236800971
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 236800971
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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