Provider Demographics
NPI:1386631422
Name:CML INC
Entity Type:Organization
Organization Name:CML INC
Other - Org Name:TIERRA ROSE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-585-4602
Mailing Address - Street 1:4254 WEATHERS ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1933
Mailing Address - Country:US
Mailing Address - Phone:503-585-4602
Mailing Address - Fax:503-585-6002
Practice Address - Street 1:4254 WEATHERS ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1933
Practice Address - Country:US
Practice Address - Phone:503-585-4602
Practice Address - Fax:503-585-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR805788313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR805788Medicaid