Provider Demographics
NPI:1780200501
Name:RSL SALEM, LLC
Entity Type:Organization
Organization Name:RSL SALEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-595-2810
Mailing Address - Street 1:10220 SW GREENBURG RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5505
Mailing Address - Country:US
Mailing Address - Phone:503-595-2810
Mailing Address - Fax:503-595-2818
Practice Address - Street 1:960 BOONE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1527
Practice Address - Country:US
Practice Address - Phone:503-363-2273
Practice Address - Fax:503-363-4991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIANT COMPANIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR522962Medicaid
OR522963Medicaid
OR1206142663OtherRESIDENTIAL CARE FACILITY LICENSE