NPI 1669633707
Jefferson Manor Residential Care, LLC
Practice location
- Address
- 664 SE Jefferson St, Dallas, OR 97338-2024
- Phone
- (503) 623-8104
- Fax
- (503) 623-0772
- Mailing address
- 200 Hawthorne Ave SE STE A140, Salem, OR 97301-5092
Authorised official
- Name
- Elizabeth Marie Moss
- Title
- Director of Risk Management
- Phone
- (503) 588-2725
Registered specialties
Alzheimer Center (Dementia Center)
Primary
Registry record
- NPI
- 1669633707
- Entity type
- Organization
- NPI issued
- 20 Jun 2008
- Record last updated
- 20 Jun 2008
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.