Organization
GRAND VICTORIAN OF STERLING MASTER LESSEE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOLTZ (CONTROLLER)
(541) 747-3373
Entity
Organization
Contact information
Practice address
2705 AVENUE E, STERLING, IL 61081-9016
(815) 622-2800
(815) 622-2801
Mailing address
78 CENTENNIAL LOOP, EUGENE, OR 97401-7900
(541) 747-3373
(541) 868-8447
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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