Provider Demographics
NPI:1851387179
Name:CARE CENTER (LANECO) INC
Entity Type:Organization
Organization Name:CARE CENTER (LANECO) INC
Other - Org Name:CRESWELL HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VISLOCKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-735-7155
Mailing Address - Street 1:7700 NE PARKWAY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6648
Mailing Address - Country:US
Mailing Address - Phone:360-735-7155
Mailing Address - Fax:360-735-9416
Practice Address - Street 1:735 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-7507
Practice Address - Country:US
Practice Address - Phone:541-895-3333
Practice Address - Fax:541-895-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800071Medicaid
OR800071Medicaid