Provider Demographics
NPI:1972633261
Name:CLAYDAVISSTROUD - OREGON, LLC
Entity Type:Organization
Organization Name:CLAYDAVISSTROUD - OREGON, LLC
Other - Org Name:SUN TERRACE HERMISTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:541-564-2595
Mailing Address - Street 1:1550 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6692
Mailing Address - Country:US
Mailing Address - Phone:541-564-2595
Mailing Address - Fax:541-564-3087
Practice Address - Street 1:1550 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6692
Practice Address - Country:US
Practice Address - Phone:541-564-2595
Practice Address - Fax:541-564-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR70M248310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility