NPI 1275721268

Maple Ridge Assisted Living Community LLC

Organisation Exclusive Provider Organization Salem, OR

Practice location

Address: 3220 State St Suite 200, Salem, OR 97301-6872
Phone: (503) 566-5715
Fax: (503) 588-3531
Mailing address: 1767 Alliance Ave, Freeland, WA 98249-9448

Authorised official

Name: Kelley D Hamilton
Title: Ceo and President of Manager
Phone: (503) 566-5715

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 1966 (WA)

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Registry record

NPI: 1275721268
Entity type: Organization
NPI issued: 4 Oct 2007
Record last updated: 4 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.