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General NPI Number Information
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NPI Number | 1376423624
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Entity Type | Organization
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Legal Business Name | MONMOUTH RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 09/06/2025
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Last Update Date | 09/06/2025
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Provider Practice Location Address
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Address Line | 373 ATWATER ST S
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City | MONMOUTH
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State | OR
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Zip | 97361-9705
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Country | US
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Telephone | 971-381-0765
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Fax | 503-837-0854
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Provider Business Mailing Address
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Address Line | 373 ATWATER ST S
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City | MONMOUTH
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State | OR
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Zip | 97361-9705
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Country | US
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Telephone |
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Fax | 503-837-0854
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Authorized Official
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Title or Position | LICENSEE
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Name | SAMUEL NGARUIYA
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Credential |
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Telephone | 971-381-0765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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