Provider Demographics
NPI:1134495039
Name:WEST LINN CARE CENTER OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:WEST LINN CARE CENTER OPERATING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-706-0878
Mailing Address - Street 1:20300 S SOUTH END RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7700
Mailing Address - Country:US
Mailing Address - Phone:503-706-0878
Mailing Address - Fax:
Practice Address - Street 1:2330 DEBOK RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3902
Practice Address - Country:US
Practice Address - Phone:503-655-0474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1565662204313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38E018Medicaid
OR38E018Medicaid