Provider Demographics
NPI:1285044636
Name:HARTFORD HOME
Entity Type:Organization
Organization Name:HARTFORD HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR/COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KAIOLANI
Authorized Official - Middle Name:B
Authorized Official - Last Name:CALIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-838-2114
Mailing Address - Street 1:294 WHITMAN ST S
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-2035
Mailing Address - Country:US
Mailing Address - Phone:503-838-2114
Mailing Address - Fax:503-837-0683
Practice Address - Street 1:294 WHITMAN ST S
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2035
Practice Address - Country:US
Practice Address - Phone:503-838-2114
Practice Address - Fax:503-837-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5190913104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness