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General NPI Number Information
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NPI Number | 1316885189
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Entity Type | Organization
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Legal Business Name | PLCV III OPERATION, LLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 525 SW ANIQUE LN
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City | GRANTS PASS
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State | OR
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Zip | 97526-5416
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Country | US
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Telephone | 541-474-4376
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Fax |
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Provider Business Mailing Address
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Address Line | 25260 SW PARKWAY AVE STE B
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City | WILSONVILLE
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State | OR
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Zip | 97070-6627
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Country | US
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Telephone | 503-826-5190
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & COO
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Name | CARL ALLEN MASON
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Credential |
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Telephone | 503-826-5190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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