Provider Demographics
NPI:1740959154
Name:WELLTOWER TENANT GROUP LLC
Entity type:Organization
Organization Name:WELLTOWER TENANT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-443-1818
Mailing Address - Street 1:7420 SW BRIDGEPORT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7790
Mailing Address - Country:US
Mailing Address - Phone:503-597-4906
Mailing Address - Fax:
Practice Address - Street 1:8525 URBANDALE AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4108
Practice Address - Country:US
Practice Address - Phone:515-331-0970
Practice Address - Fax:515-331-8935
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLTOWER TENANT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility