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General NPI Number Information
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NPI Number | 1275159030
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Entity Type | Organization
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Legal Business Name | NEWBERG MEMORY ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 317 N WERTH BLVD
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City | NEWBERG
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State | OR
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Zip | 97132-7538
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Country | US
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Telephone | 503-538-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 7420 SW BRIDGEPORT RD STE 105
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City | PORTLAND
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State | OR
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Zip | 97224-7790
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Country | US
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Telephone | 503-597-4906
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | GREGORY A. RODERICK
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Credential |
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Telephone | 503-443-1818
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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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