Provider Demographics
NPI:1376169292
Name:ADVOCATE CARE LLC
Entity Type:Organization
Organization Name:ADVOCATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:WOOLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-601-6070
Mailing Address - Street 1:3140 JUANIPERO WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8647
Mailing Address - Country:US
Mailing Address - Phone:541-608-2868
Mailing Address - Fax:541-772-0115
Practice Address - Street 1:13033 SE HOLGATE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3913
Practice Address - Country:US
Practice Address - Phone:971-271-8457
Practice Address - Fax:971-271-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR525557Medicaid