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General NPI Number Information
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NPI Number | 1568509966
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Entity Type | Organization
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Legal Business Name | MILWAUKIE CONVALESCENT HOSPITAL INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 12045 SE STANLEY AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 503-659-2323
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Fax | 503-353-8533
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Provider Business Mailing Address
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Address Line | 12045 SE STANLEY AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 503-659-2323
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Fax | 503-353-8533
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Authorized Official
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Title or Position | GM
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Name | DAVID EIVERS
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Credential |
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Telephone | 503-659-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | OR
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