Organization
SENIOR HAVEN LLC
Active
Other names
Senior Haven RCF
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT AUSTIN EVANS (MANAGING MEMBER)
(541) 317-9188
Entity
Organization
Contact information
Practice address
12140 SE FOSTER RD, PORTLAND, OR 97266-4043
(971) 271-8975
Mailing address
PO BOX 1410, BEND, OR 97709-1410
(541) 317-9188
(541) 389-3710
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164402
—
OR
Enumeration date
05/08/2020
Last updated
05/08/2020
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