Quail Park of Klamath Falls, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1090374171 Issued in OR

Legal business name

QUAIL PARK OF KLAMATH FALLS, LLC

Doing business as

Quail Park at Crystal Terrace

Practice address

1000 Town Center Dr
Klamath Falls, OR 97601-7137

Phone

(541) 885-7250

Fax

(541) 882-8882

NPI assigned

Apr 5, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Denis R Bryant

Title

Managing Member

Phone

(206) 441-1770

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Quail Park at Crystal Terrace Doing business as

Locations

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1538425368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "146 N CANAL ST",
            "address_2": "STE 220",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981038691",
            "telephone_number": "206-441-1770",
            "fax_number": "206-441-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWN CENTER DR",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976017137",
            "telephone_number": "541-885-7250",
            "fax_number": "541-882-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUAIL PARK OF KLAMATH FALLS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "DENIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "206-441-1770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OR",
            "license": "1090374171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "523250",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quail Park at Crystal Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathleen A Puffenbarger, FNP
• Cole Carlon Puffer, MD
• Alana-Marie Pulkkinen
• Diane Putnam
• Eva Marie Pyle
• Steven Edward Quick, BS
• Paula Heather Quinn
• Cassidy Lee Quistorff
• Rachel Raines
• Haven Rainey

• Assisted Living Facility in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Assisted Living Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.