Provider Demographics
NPI:1457106049
Name:AHR ROGUE RIVER OR ALF TRS SUB LLC
Entity Type:Organization
Organization Name:AHR ROGUE RIVER OR ALF TRS SUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY & WELLNESS LEADER
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-582-8200
Mailing Address - Street 1:176 WARDS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:176 WARDS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9670
Practice Address - Country:US
Practice Address - Phone:541-582-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility