Provider Demographics
NPI:1699390997
Name:MEADOWBROOK PLACE OPERATIONS, LLC
Entity Type:Organization
Organization Name:MEADOWBROOK PLACE OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-255-4647
Mailing Address - Street 1:15900 SE 82ND DR
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9502
Mailing Address - Country:US
Mailing Address - Phone:503-255-4647
Mailing Address - Fax:
Practice Address - Street 1:4000 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1649
Practice Address - Country:US
Practice Address - Phone:541-523-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility