Organization
VILLAGE HEALTH CARE I, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN JESSE MARCOFF (CONTROLLER)
(503) 665-0183
Entity
Organization
Contact information
Practice address
3955 SE 182ND AVE, GRESHAM, OR 97030-5036
(503) 665-0183
(503) 666-6609
Mailing address
3955 SE 182ND AVE, GRESHAM, OR 97030-5036
(503) 665-0183
(503) 666-6609
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1124599635
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800120
—
OR
Enumeration date
08/12/2008
Last updated
08/12/2008
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