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General NPI Number Information
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NPI Number | 1023486883
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Entity Type | Organization
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Legal Business Name | BAYCREST ESTATES, LLC
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 3959 SHERIDAN AVE
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City | NORTH BEND
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State | OR
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Zip | 97459-2834
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Country | US
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Telephone | 541-756-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 4676 COMMERCIAL ST SE # 958
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City | SALEM
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State | OR
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Zip | 97302-1902
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Country | US
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Telephone | 503-689-1808
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Fax | 503-585-1268
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KENT M EMRY
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Credential |
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Telephone | 503-884-0895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | OR
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