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General NPI Number Information
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NPI Number | 1881211852
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Entity Type | Organization
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Legal Business Name | CHANCELLOR HEALTH CARE OF CALIFORNIA IX, INC.
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 14550 SE VISTA LN
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City | MILWAUKIE
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State | OR
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Zip | 97267-1731
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Country | US
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Telephone | 503-659-2325
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Fax |
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Provider Business Mailing Address
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Address Line | 115 JOHNSON ST
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City | WINDSOR
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State | CA
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Zip | 95492-7435
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Country | US
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Telephone | 707-291-3582
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Fax | 707-687-1912
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Authorized Official
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Title or Position | PRESIDENT & CHIEF FINACIAL OFFICER
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Name | CLUNEY STAGG
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Credential |
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Telephone | 707-291-3582
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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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