Provider Demographics
NPI:1689095580
Name:3707 OREGON LLC
Entity Type:Organization
Organization Name:3707 OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HIETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-244-9504
Mailing Address - Street 1:19412 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7103
Mailing Address - Country:US
Mailing Address - Phone:907-244-9504
Mailing Address - Fax:
Practice Address - Street 1:3707 OREGON DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2638
Practice Address - Country:US
Practice Address - Phone:907-244-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1010323104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness