Organization
CLEARWATER SPRINGS AL GR, LLC
Active
Other names
Clearwater Springs Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY RODERICK (MEMBER)
(503) 443-1818
Entity
Organization
Contact information
Practice address
201 NW 78TH ST, VANCOUVER, WA 98665-7904
(360) 546-3344
Mailing address
7420 SW BRIDGEPORT RD STE 105, PORTLAND, OR 97224-7790
(503) 597-4906
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207240
—
WA
Enumeration date
06/22/2020
Last updated
06/22/2020
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