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General NPI Number Information
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NPI Number | 1194265512
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Entity Type | Organization
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Legal Business Name | OCEAN PARK MEMORY CARE
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Dates
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Enumeration Date | 03/04/2017
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Last Update Date | 03/04/2017
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Provider Practice Location Address
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Address Line | 984 PARKVIEW DR
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City | BROOKINGS
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State | OR
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Zip | 97415-9116
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Country | US
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Telephone | 541-469-6817
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Fax | 541-469-3768
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Provider Business Mailing Address
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Address Line | 984 PARKVIEW DR
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City | BROOKINGS
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State | OR
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Zip | 97415-9116
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Country | US
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Telephone | 541-469-6817
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Fax | 541-469-3768
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GEORGIA LEA BOROWSKI
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Credential |
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Telephone | 541-469-6817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 1200298487
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License Number State | OR
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