Jefferson Manor Residential Care, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

1087658107 Issued in OR

Legal business name

JEFFERSON MANOR RESIDENTIAL CARE, LLC

Practice address

664 SE Jefferson St
Dallas, OR 97338-2024

Phone

(503) 623-8104

Fax

(503) 623-0772

NPI assigned

Jun 20, 2008

Organization subpart

No

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

Authorized official

Name

Elizabeth Marie Moss

Title

Director of Risk Management

Phone

(503) 588-2725

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jefferson Manor Doing business as

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

{
    "created_epoch": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1669633707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE AVE SE STE A140",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973015092",
            "telephone_number": "503-588-2725",
            "fax_number": "503-588-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "664 SE JEFFERSON ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382024",
            "telephone_number": "503-623-8104",
            "fax_number": "503-623-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON MANOR RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF RISK MANAGEMENT",
        "authorized_official_telephone_number": "503-588-2725"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "OR",
            "license": "1087658107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "515448",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Ryan Jamar
• James Dental Group PC
• Alisha James, D.D.S
• Benjamin James, D.D.S.
• Kamielle James
• Ying Jin
• James Henry Joerger, PSYCHOLOGIST
• Christopher David Johnson, OD
• Connie R Johnson, MS
• David Christopher Johnson, OD

• Alzheimer Center (Dementia Center) in Dallas, OR
• Providers in Dallas, OR by specialty
• Alzheimer Center (Dementia Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; 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.