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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