Provider Demographics
NPI:1962028332
Name:CROWN TWO DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:CROWN TWO DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-610-5847
Mailing Address - Street 1:20058 BETH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3067
Mailing Address - Country:US
Mailing Address - Phone:541-610-5847
Mailing Address - Fax:
Practice Address - Street 1:155 S EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-2974
Practice Address - Country:US
Practice Address - Phone:503-982-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility