Organization
PROVIDENCE SILVERTON REHAB LLC
Active
Parent organization
PROVIDENCE SILVERTON REHAB LLC
Other names
WELLSPRING PHYSICAL REHABILITATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE SILVERTON REHAB LLC
Authorized official
DANA L MONTGOMERY (CHIEF FINANCIAL OFFICER)
(503) 893-7295
Entity
Organization
Contact information
Practice address
1475 MT. HOOD AVE, WOODBURN, OR 97071-9066
(971) 983-5206
(971) 983-5211
Mailing address
PO BOX 3290, PORTLAND, OR 97208-3290
(503) 215-4323
(503) 215-0297
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA5512
RAILROAD MEDICARE PART B
OR
Enumeration date
06/19/2007
Last updated
10/01/2012
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