MEDICARE: PREFERRED COMMUNITY HOMES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		ID

General Provider Information

NPI Number	:	1154508471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED COMMUNITY HOMES, LLC

Provider Business Mailing Address
First Line	:	3155 RIVER RD S STE 100
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9819
Country	:	US
Telephone Number	:	503-362-5235
Fax Number	:	503-585-3267

Provider Business Practice Location Address
First Line	:	7091 W EMERALD ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-8618
Country	:	US
Telephone Number	:	208-855-9142
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASON MCARTHUR
Credential	:
Telephone Number	:	503-362-5235

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	01/29/2008

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