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Organization
CLAIR'S II ADULT FOSTER HOME LLC
Active
Organization
CLAIR'S II ADULT FOSTER HOME LLC
Active
Other names
Clair's Two Adult Foster Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY JAMES BOYSUN I (PPO)
(541) 269-7955
Entity
Organization
Contact information
Practice address
63249 EVEREST RD, COOS BAY, OR 97420-7238
(541) 269-7955
(541) 269-7955
Mailing address
63249 EVEREST RD, COOS BAY, OR 97420-7238
(541) 269-7955
(541) 269-7955
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
374U00000X
Home Health Aide
—
—
376K00000X
Nurse's Aide
—
—
385H00000X
Respite Care
—
—
405300000X
Prevention Professional
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500697484
—
OR
01
—
525988
STATE OF OREGON
OR
Enumeration date
12/09/2019
Last updated
12/09/2019
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