Provider Demographics
NPI:1023494747
Name:TOUCHMARK AT MEADOW LAKE VILLAGE REITREMENT RESORT, LLC
Entity type:Organization
Organization Name:TOUCHMARK AT MEADOW LAKE VILLAGE REITREMENT RESORT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-646-5186
Mailing Address - Street 1:4037 E CLOCKTOWER LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8183
Mailing Address - Country:US
Mailing Address - Phone:208-888-2277
Mailing Address - Fax:208-888-9159
Practice Address - Street 1:4037 E CLOCKTOWER LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8183
Practice Address - Country:US
Practice Address - Phone:208-888-2277
Practice Address - Fax:208-888-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty