Provider Demographics
NPI:1609486828
Name:NORTHRIDGE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:NORTHRIDGE SENIOR LIVING, LLC
Other - Org Name:NORTHRIDGE CENTER INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEMORY
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:SALLIOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-6943
Mailing Address - Street 1:2979 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8397
Mailing Address - Country:US
Mailing Address - Phone:541-779-6943
Mailing Address - Fax:
Practice Address - Street 1:2979 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8397
Practice Address - Country:US
Practice Address - Phone:541-779-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care