Provider Demographics
NPI:1710166145
Name:CLAY-DAVIS STROUD, LLC
Entity Type:Organization
Organization Name:CLAY-DAVIS STROUD, LLC
Other - Org Name:SUN TERRACE AT PROSSER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-4066
Mailing Address - Street 1:2131 WINE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1389
Mailing Address - Country:US
Mailing Address - Phone:509-796-3300
Mailing Address - Fax:
Practice Address - Street 1:2131 WINE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1389
Practice Address - Country:US
Practice Address - Phone:509-796-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility