Provider Demographics
NPI:1972032126
Name:CSL - CORVALLIS, LLC
Entity Type:Organization
Organization Name:CSL - CORVALLIS, LLC
Other - Org Name:REGENT COURT SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT, LEGAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSYTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-636-3460
Mailing Address - Street 1:1580 VALLEY RIVER DR STE 260
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2193
Mailing Address - Country:US
Mailing Address - Phone:541-636-3460
Mailing Address - Fax:541-636-3797
Practice Address - Street 1:400 NW ELKS DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3744
Practice Address - Country:US
Practice Address - Phone:541-758-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1480724513311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1480724513Medicaid