Organization
FOSTER CREEK OPERATING COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA LEE WALDROFF (MANAGER MANAGED, MANAGING MEMBER)
(503) 706-0878
Entity
Organization
Contact information
Practice address
6003 SE 136TH AVE, PORTLAND, OR 97236-4567
(503) 761-1155
Mailing address
PO BOX 1980, GRESHAM, OR 97030-0587
(503) 701-1412
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38E126
—
OR
Enumeration date
04/06/2012
Last updated
04/06/2012
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