MEDICARE: HOLIDAY AL NIC MANAGEMENT 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972054989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLIDAY AL NIC MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	5885 MEADOWS RD
Second Line	:	SUITE 500
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-8639
Country	:	US
Telephone Number	:	971-245-8020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 MEADOWS RD
Second Line	:	SUITE 500
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-8639
Country	:	US
Telephone Number	:	971-245-8020
Fax Number	:

Authorized Official
Title or Position	:	PARALEGAL FOR MANAGEMENT COMPANY
Name	:	DIANE L THOMPSON
Credential	:
Telephone Number	:	971-245-8020

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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MEDICARE: HOLIDAY AL NIC MANAGEMENT LLC

Scope of Practice

Other Identifiers

General Provider Information

Similar Medicare Providers

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