Provider Demographics
NPI:1609314509
Name:CATHERINE JENSENS FOSTER HOME
Entity Type:Organization
Organization Name:CATHERINE JENSENS FOSTER HOME
Other - Org Name:EDDY'S OLD FASHIONED HAMBURGERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ADD
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-299-0370
Mailing Address - Street 1:108 ASH DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-299-0370
Mailing Address - Fax:541-582-8218
Practice Address - Street 1:108 ASH DRIVE
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537
Practice Address - Country:US
Practice Address - Phone:541-299-0370
Practice Address - Fax:541-582-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR580410311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home