Provider Demographics
NPI:1952595340
Name:INLAND POINT SENIOR ESTATES JV LLC
Entity Type:Organization
Organization Name:INLAND POINT SENIOR ESTATES JV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-756-0176
Mailing Address - Street 1:3696 BROADWAY ST
Mailing Address - Street 2:PMB 132
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2200
Mailing Address - Country:US
Mailing Address - Phone:541-756-9740
Mailing Address - Fax:541-756-9739
Practice Address - Street 1:2265 INLAND DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-9740
Practice Address - Fax:541-756-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAPPLIED FOR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274679Medicaid
ORR140486Medicare UPIN