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General NPI Number Information
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NPI Number | 1942162631
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Entity Type | Organization
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Legal Business Name | WILLAMETTE MANOR, INC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 176 W C ST
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City | LEBANON
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State | OR
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Zip | 97355-3193
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Country | US
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Telephone | 541-258-8178
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Fax | 541-258-8197
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Provider Business Mailing Address
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Address Line | 176 W C ST
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City | LEBANON
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State | OR
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Zip | 97355-3193
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Country | US
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Telephone | 541-258-8178
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Fax | 541-258-8197
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Authorized Official
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Title or Position | PRESIDENT/ COO
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Name | CARL MASON
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Credential |
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Telephone | 503-826-5190
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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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