Provider Demographics
NPI:1457702417
Name:KLAMATH FALLS MSL LLC
Entity Type:Organization
Organization Name:KLAMATH FALLS MSL LLC
Other - Org Name:THE RETREAT AT SUNRIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-242-1415
Mailing Address - Street 1:4 PARK PLZ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8560
Mailing Address - Country:US
Mailing Address - Phone:949-242-1428
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7137
Practice Address - Country:US
Practice Address - Phone:949-242-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility