Organization
PROVIDENCE ELDERPLACE
Active
Parent organization
PROVIDENCE HEALTH SYSTEMS
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH SYSTEMS
Authorized official
LOMINGO M ANDREWS (LPN)
(503) 546-9292
Entity
Organization
Contact information
Practice address
16430 NE HOYT ST, PORTLAND, OR 97230
(503) 875-5172
Mailing address
16430 NE HOYT ST, PORTLAND, OR 97230-5846
(503) 875-5172
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
201130602LPN
OR
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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