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General NPI Number Information
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NPI Number | 1972054989
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Entity Type | Organization
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Legal Business Name | HOLIDAY AL NIC MANAGEMENT LLC
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 5885 MEADOWS RD SUITE 500
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8639
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Country | US
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Telephone | 971-245-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 5885 MEADOWS RD SUITE 500
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8639
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Country | US
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Telephone | 971-245-8020
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Fax |
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Authorized Official
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Title or Position | PARALEGAL FOR MANAGEMENT COMPANY
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Name | DIANE L THOMPSON
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Credential |
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Telephone | 971-245-8020
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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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