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General NPI Number Information
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NPI Number | 1073732434
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Entity Type | Organization
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Legal Business Name | BD PRINEVILLE II LLC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 950 NE ELM ST
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City | PRINEVILLE
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State | OR
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Zip | 97754-1619
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Country | US
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Telephone | 541-447-7667
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Fax | 541-447-6685
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Provider Business Mailing Address
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Address Line | 3326 160TH AVE SE SUITE 120
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City | BELLEVUE
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State | WA
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Zip | 98008-6418
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Country | US
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Telephone | 425-392-4066
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Fax | 425-623-1517
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DOUG DEVORE
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Credential |
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Telephone | 425-392-4066
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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 | 1392620563
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License Number State | OR
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