NPIMap

Organization Active NPI

Maple Ridge Assisted Living Community LLC

Doing business as Maple Ridge Assisted Living Community

  • Exclusive Provider Organization
  • Salem, OR
National Provider Identifier
1275721268
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
License
1966 Issued in WA
Legal business name
MAPLE RIDGE ASSISTED LIVING COMMUNITY LLC
Doing business as
Maple Ridge Assisted Living Community
Practice address
3220 State St
Suite 200
Salem, OR 97301-6872
Phone
(503) 566-5715
Fax
(503) 588-3531
NPI assigned
Oct 4, 2007
Last updated
Oct 4, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X 1966 WA Primary

Addresses

Primary practice location

3220 State St
Suite 200
Salem, OR 97301-6872

Mailing address

1767 Alliance Ave
Freeland, WA 98249-9448
Phone (360) 331-1303

Other names 1

  • Maple Ridge Assisted Living Community Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Maple Ridge Assisted Living Community2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1275721268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1767 ALLIANCE AVE",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982499448",
            "telephone_number": "360-331-1303",
            "fax_number": "360-331-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 STATE ST",
            "address_2": "SUITE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016872",
            "telephone_number": "503-566-5715",
            "fax_number": "503-588-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE RIDGE ASSISTED LIVING COMMUNITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO AND PRESIDENT OF MANAGER",
        "authorized_official_telephone_number": "503-566-5715",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "WA",
            "license": "1966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Ridge Assisted Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.