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General NPI Number Information
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NPI Number | 1396229787
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Entity Type | Organization
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Legal Business Name | BISHOP SUGARLAND RIDGE LESSEE LLC
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1551 SUGARLAND DR
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City | SHERIDAN
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State | WY
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Zip | 82801-5721
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Country | US
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Telephone | 307-674-5575
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Fax | 307-674-8070
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Provider Business Mailing Address
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Address Line | 5885 MEADOWS RD STE 500
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8646
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Country | US
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Telephone | 971-254-1368
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | TRACEY GAMBLE
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Credential |
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Telephone | 212-472-4067
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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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