Provider Demographics
NPI:1578886834
Name:AIDAN SENIOR LIVING AT REEDSPORT INC.
Entity Type:Organization
Organization Name:AIDAN SENIOR LIVING AT REEDSPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-588-4428
Mailing Address - Street 1:180 COMMERCIAL ST NE STE 11
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3486
Mailing Address - Country:US
Mailing Address - Phone:503-588-4428
Mailing Address - Fax:503-588-1087
Practice Address - Street 1:600 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1720
Practice Address - Country:US
Practice Address - Phone:541-271-2171
Practice Address - Fax:541-271-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500621067Medicaid
OR385164Medicare Oscar/Certification