Provider Demographics
NPI:1578189114
Name:EUGENE SOUTHTOWNE LIVING CENTER LLC
Entity Type:Organization
Organization Name:EUGENE SOUTHTOWNE LIVING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-8929
Mailing Address - Street 1:205 SE WILSON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1799
Mailing Address - Country:US
Mailing Address - Phone:541-389-8929
Mailing Address - Fax:
Practice Address - Street 1:389 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2726
Practice Address - Country:US
Practice Address - Phone:541-683-3618
Practice Address - Fax:541-342-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)