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General NPI Number Information
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NPI Number | 1558987768
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Entity Type | Organization
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Legal Business Name | GREENRIDGE ESTATES OPERATING LLC
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 06/23/2020
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Provider Practice Location Address
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Address Line | 4 GREENRIDGE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1400
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Country | US
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Telephone | 503-635-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GREENRIDGE DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-1400
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WINSTON TONACK
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Credential |
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Telephone | 503-550-7170
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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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