Organization
JEFFERSON MANOR RESIDENTIAL CARE, LLC
Active
Other names
Jefferson Manor
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH MARIE MOSS (DIRECTOR OF RISK MANAGEMENT)
(503) 588-2725
Entity
Organization
Contact information
Practice address
664 SE JEFFERSON ST, DALLAS, OR 97338-2024
(503) 623-8104
(503) 623-0772
Mailing address
200 HAWTHORNE AVE SE STE A140, SALEM, OR 97301-5092
(503) 588-2725
(503) 588-8653
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
1087658107
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
515448
—
OR
Enumeration date
06/20/2008
Last updated
06/20/2008
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