Organization
TOUCHMARK AT MEADOW LAKE VILLAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN EUGENE PRYOR (EXECUTIVE VICE PRESIDENT)
(503) 646-5186
Entity
Organization
Contact information
Practice address
625 S ARBOR LN, MERIDIAN, ID 83642-3025
(208) 884-3308
(208) 888-9381
Mailing address
5150 SW GRIFFITH DR, BEAVERTON, OR 97005-2935
(503) 646-5186
(503) 644-3568
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HH160
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13D0947553
CLIA WAIVER
ID
01
—
HH160
STATE LICENSURE
ID
Enumeration date
12/28/2010
Last updated
02/12/2018
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