Organization
FOREST DRIVE OPERATIONS, LLC
Active
Other names
Suzanne Elise Assisted Living Facility
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KARL RICKARD MILLER JR. (OWNER)
(503) 570-3405
Entity
Organization
Contact information
Practice address
101 FOREST DR, SEASIDE, OR 97138-7867
(503) 738-0307
(503) 717-8102
Mailing address
101 FOREST DR, SEASIDE, OR 97138-7867
(503) 738-0307
(503) 717-8102
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
1847571968
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
517786
—
OR
Enumeration date
07/28/2008
Last updated
07/28/2008
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