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General NPI Number Information
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NPI Number | 1699623934
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Entity Type | Organization
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Legal Business Name | BOONE ROAD SENIOR LIVING LLC
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 2950 BOONE RD SE
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City | SALEM
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State | OR
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Zip | 97306-9399
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Country | US
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Telephone | 971-287-6016
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Fax | 971-443-5157
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Provider Business Mailing Address
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Address Line | 650 HAWTHORNE AVE SE STE 210
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City | SALEM
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State | OR
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Zip | 97301-5895
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Country | US
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Telephone | 503-391-9999
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Fax | 971-443-5157
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Authorized Official
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Title or Position | EQUITY AND DEBT RELATIONSHIP MANAGE
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Name | KATY BISHOP
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Credential | BISHOP
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Telephone | 503-391-9999
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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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