Provider Demographics
NPI: | 1518312743 |
---|---|
Name: | SHERIDAN OPERATIONS, LLC |
Entity Type: | Organization |
Organization Name: | SHERIDAN OPERATIONS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHAIRMAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KARL |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 503-570-3405 |
Mailing Address - Street 1: | 25117 SW PARKWAY AVE |
Mailing Address - Street 2: | SUITE F |
Mailing Address - City: | WILSONVILLE |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97070-9697 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-570-3405 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3959 SHERIDAN AVE |
Practice Address - Street 2: | |
Practice Address - City: | NORTH BEND |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97459-2834 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-982-2995 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-25 |
Last Update Date: | 2016-04-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | 385039 | Medicare Oscar/Certification |