Organization
STAYTON SW ASSISTED LIVING LLC
Active
Other names
Lakeside Assisted Living Community
Organization subpart
No
Provider details
NPI number
Authorized official
JON M HARDER (MANAGER)
(503) 485-4600
Entity
Organization
Contact information
Practice address
2201 3RD AVENUE, STAYTON, OR 97383-1388
(503) 769-3200
Mailing address
PO BOX 3006, SALEM, OR 97302-0006
(503) 375-9016
(503) 485-1279
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
1769313990
OR
310400000X
Assisted Living Facility
Primary
—
OR
Other
Enumeration date
03/25/2007
Last updated
07/14/2008
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