Provider Demographics
NPI:1700428687
Name:MELODY COURT MEMORY CARE, LLC
Entity Type:Organization
Organization Name:MELODY COURT MEMORY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:II
Authorized Official - Credentials:BSME
Authorized Official - Phone:503-267-1753
Mailing Address - Street 1:5732 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4604
Mailing Address - Country:US
Mailing Address - Phone:503-761-3434
Mailing Address - Fax:
Practice Address - Street 1:5732 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4604
Practice Address - Country:US
Practice Address - Phone:503-761-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)