Provider Demographics
NPI:1356177992
Name:WATERFRONT HOMECARE LLC
Entity type:Organization
Organization Name:WATERFRONT HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AAIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-375-0166
Mailing Address - Street 1:86895 N BANK LN
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-8613
Mailing Address - Country:US
Mailing Address - Phone:541-375-0166
Mailing Address - Fax:
Practice Address - Street 1:730 SE FLINT ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3428
Practice Address - Country:US
Practice Address - Phone:541-375-0166
Practice Address - Fax:541-637-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home