Provider Demographics
NPI:1871774455
Name:MAPLE RIDGE RETIREMENT & ASSISTED LIVING COMMUNITY LLC
Entity type:Organization
Organization Name:MAPLE RIDGE RETIREMENT & ASSISTED LIVING COMMUNITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT OF MANAGEMENT COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-373-3125
Mailing Address - Street 1:3220 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-6872
Mailing Address - Country:US
Mailing Address - Phone:503-373-3125
Mailing Address - Fax:503-588-3531
Practice Address - Street 1:1767 ALLIANCE AVE
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9448
Practice Address - Country:US
Practice Address - Phone:360-331-1303
Practice Address - Fax:360-331-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1966305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service