Provider Demographics
NPI:1245816461
Name:SELLWOOD SENIOR LIVING LLC
Entity type:Organization
Organization Name:SELLWOOD SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:UHLIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-276-7390
Mailing Address - Street 1:2334 WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2159
Mailing Address - Country:US
Mailing Address - Phone:530-276-7390
Mailing Address - Fax:
Practice Address - Street 1:8517 SE 17TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7347
Practice Address - Country:US
Practice Address - Phone:503-782-6073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility