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General NPI Number Information
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NPI Number | 1679985113
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Entity Type | Organization
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Legal Business Name | STATE OF OREGON DEPARTMENT OF VETERANS' AFFAIRS
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 600 N. 5TH STREET
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City | LEBANON
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State | OR
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Zip | 97355
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Country | US
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Telephone | 503-362-5235
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N. 5TH STREET
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City | LEBANON
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State | OR
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Zip | 97355
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Country | US
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Telephone | 503-362-5235
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | BRUCE SHRIVER
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Credential |
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Telephone | 503-373-2268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | OR
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