=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578886834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIDAN SENIOR LIVING AT REEDSPORT INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2010
-----------------------------------------------------
Last Update Date | 12/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 RANCH RD
-----------------------------------------------------
City | REEDSPORT
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97467-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-271-2171
-----------------------------------------------------
Fax | 541-271-2941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 COMMERCIAL ST NE STE 11
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97301-3486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-588-4428
-----------------------------------------------------
Fax | 503-588-1087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. TROY N ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-588-4428
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------