=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386207165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MH OREGON OPERATING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2019
-----------------------------------------------------
Last Update Date | 04/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3450 SEAMAN RD
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43616-2497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-907-0186
-----------------------------------------------------
Fax | 419-693-9715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3450 SEAMAN RD
-----------------------------------------------------
City | OREGON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43616-2497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-907-0186
-----------------------------------------------------
Fax | 419-693-9715
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REIMBURSEMENT ANALYST
-----------------------------------------------------
Name | MR. HENRY J VAUGHN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-595-6025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------