Organization
GENTOG, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCIE M JONES (CO-PRESIDENT)
(503) 639-2600
Entity
Organization
Contact information
Practice address
11535 SW DURHAM RD, SUITE C5, TIGARD, OR 97224-3474
(503) 639-2600
Mailing address
11535 SW DURHAM RD, SUITE C5, TIGARD, OR 97224-3474
(503) 639-2600
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
699816
—
OR
Enumeration date
07/27/2010
Last updated
07/27/2010
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