Provider Demographics
NPI:1376251710
Name:UMPQUA RIVER NURSING & REHAB LLC
Entity Type:Organization
Organization Name:UMPQUA RIVER NURSING & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-359-5401
Mailing Address - Street 1:4055 SHELBYVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3106
Mailing Address - Country:US
Mailing Address - Phone:502-655-3083
Mailing Address - Fax:
Practice Address - Street 1:525 W UMPQUA ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2952
Practice Address - Country:US
Practice Address - Phone:541-464-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility