Provider Demographics
NPI: | 1790903391 |
---|---|
Name: | CAMBRIDGE PLACE GF, LLC |
Entity Type: | Organization |
Organization Name: | CAMBRIDGE PLACE GF, LLC |
Other - Org Name: | CAMBRIDGE PLACE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARDER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 503-485-4600 |
Mailing Address - Street 1: | 3723 FAIRVIEW INDUSTRIAL DR SE |
Mailing Address - Street 2: | SUITE 270 |
Mailing Address - City: | SALEM |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97302-1177 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-485-4600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1104 6TH AVE N |
Practice Address - Street 2: | |
Practice Address - City: | GREAT FALLS |
Practice Address - State: | MT |
Practice Address - Zip Code: | 59401-1583 |
Practice Address - Country: | US |
Practice Address - Phone: | 406-727-0447 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-22 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WY | 10823 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |