Organization
ROSEBURG ASSISTED LIVING LLC
Active
Other names
Oak Park Assisted Living Community
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLEY D HAMILTON (CEO-PRES OF MANAGER)
(503) 566-5715
Entity
Organization
Contact information
Practice address
3220 STATE ST, SUITE 200, SALEM, OR 97301-6872
(503) 566-5715
Mailing address
1400 NE ROCKY RIDGE DR, ROSEBURG, OR 97470-5673
(541) 464-5656
(541) 677-7064
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
647146-87
REGISTRY #
OR
Enumeration date
05/07/2007
Last updated
10/04/2007
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