MEDICARE: EC OPCO ONTARIO, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1548769714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EC OPCO ONTARIO, LLC

Provider Business Mailing Address
First Line	:	5885 MEADOWS RD STE 500
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-8646
Country	:	US
Telephone Number	:	971-254-1368
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 WALKER LAKE RD
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44906-1412
Country	:	US
Telephone Number	:	419-747-1119
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	AMY W. FLEMING
Credential	:
Telephone Number	:	971-337-3922

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	03/12/2019

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