Provider Demographics
NPI:1558907360
Name:GREAT FALLS SL, LLC
Entity Type:Organization
Organization Name:GREAT FALLS SL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT- MOSAIC MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-391-9999
Mailing Address - Street 1:1900 HINES ST SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1337
Mailing Address - Country:US
Mailing Address - Phone:503-391-9999
Mailing Address - Fax:503-587-8547
Practice Address - Street 1:1801 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5608
Practice Address - Country:US
Practice Address - Phone:503-391-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility