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General NPI Number Information
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NPI Number | 1073494555
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Entity Type | Organization
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Legal Business Name | BRENTWOOD SH OPCO, LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 450 JOHN MUIR PKWY
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City | BRENTWOOD
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State | CA
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Zip | 94513-5195
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Country | US
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Telephone | 925-516-8006
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Fax | 925-516-8506
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Provider Business Mailing Address
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Address Line | 560 1ST ST STE 104
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-3273
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Country | US
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Telephone | 503-675-3925
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Fax |
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Authorized Official
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Title or Position | VP OF ORG DEVELOPMENT
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Name | STEVEN BAE
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Credential |
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Telephone | 503-675-3925
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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 |
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License Number State |
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