Organization
REGENCY @ CORVALLIS, LLC
Active
Other names
Regency Park Place @ Corvallis
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG DEVORE (CFO)
(425) 392-4066
Entity
Organization
Contact information
Practice address
2595 NE JACK LONDON ST, CORVALLIS, OR 97330-6915
(541) 754-5808
Mailing address
2595 NE JACK LONDON ST, CORVALLIS, OR 97330-6915
(541) 754-5808
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659522651
STATE LICENCE
OR
Enumeration date
04/23/2009
Last updated
04/23/2009
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