Organization
TLC WEST, L.L.C.
Active
Other names
Gibson Creek Retirement & Assisted Living Facility
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
(506) 566-5715
(503) 588-3531
Mailing address
1615 BRUSH COLLEGE RD NW, SALEM, OR 97304-1400
(503) 361-8599
(503) 371-1160
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515260-86
REGISTRY #
OR
Enumeration date
05/07/2007
Last updated
10/04/2007
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