Provider Demographics
NPI:1003020686
Name:HILLSIDE SENIOR LIVING COMMUNITY, LLC
Entity type:Organization
Organization Name:HILLSIDE SENIOR LIVING COMMUNITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-CAMPUS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-472-9534
Mailing Address - Street 1:300 NW HILLSIDE PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128
Mailing Address - Country:US
Mailing Address - Phone:503-472-9534
Mailing Address - Fax:503-883-7477
Practice Address - Street 1:300 NW HILLSIDE PARK WAY
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128
Practice Address - Country:US
Practice Address - Phone:503-472-9534
Practice Address - Fax:503-883-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1022025704313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR385269Medicare ID - Type Unspecified