Organization
WELL FRONTIER TENANT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY A. RODERICK (AUTHORIZED REP.)
(503) 443-1818
Entity
Organization
Contact information
Practice address
8915 SE MONTEREY AVE, HAPPY VALLEY, OR 97086-7509
(503) 654-3200
(503) 654-3800
Mailing address
7420 SW BRIDGEPORT RD STE 105, PORTLAND, OR 97224-7790
(503) 597-4906
(503) 443-1919
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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