Organization
COAST FORK NURSING CENTER INC
Active
Other names
Coast Fork Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY J VISLOCKY (EXEC. VP OF FINANCE)
(360) 735-7155
Entity
Organization
Contact information
Practice address
515 GRANT AVE, COTTAGE GROVE, OR 97424-2967
(541) 942-5528
(541) 942-2155
Mailing address
7700 NE PARKWAY DR, SUITE 300, VANCOUVER, WA 98662-6648
(360) 735-7155
(360) 735-9416
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
809244
—
OR
Enumeration date
09/21/2005
Last updated
08/22/2020
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