Provider Demographics
NPI:1598762643
Name:UMPQUA VALLEY NURSING & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:UMPQUA VALLEY NURSING & REHABILITATION CENTER, LLC
Other - Org Name:UMPQUA VALLEY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-746-1020
Mailing Address - Street 1:1077 GATEWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1114
Mailing Address - Country:US
Mailing Address - Phone:541-746-1020
Mailing Address - Fax:541-284-7072
Practice Address - Street 1:525 W UMPQUA ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-2952
Practice Address - Country:US
Practice Address - Phone:541-677-2199
Practice Address - Fax:541-677-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-05
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR800068314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800068Medicaid
OR800068Medicaid
OR800068Medicaid