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NPI Code Detail

MEDICARE: ROGUE VALLEY MANOR

MEDICARE: ROGUE VALLEY MANOR
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
1314000000XSkilled Nursing Facility2275OR

General Provider Information

NPI Number : 1639170988
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROGUE VALLEY MANOR
Provider Business Mailing Address
First Line : 1200 MIRA MAR AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8546
Country : US
Telephone Number : 541-857-7777
Fax Number : 541-857-7590
Provider Business Practice Location Address
First Line : 1200 MIRA MAR AVE
Second Line :
City : MEDFORD
State : OR
Zip : 97504-8546
Country : US
Telephone Number : 541-857-7777
Fax Number : 541-857-7590
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DAVE L KEATON
Credential :
Telephone Number : 541-301-1592
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/11/2025

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Directions to “ROGUE VALLEY MANOR ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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