Provider Demographics
NPI:1780344812
Name:SH1 CINCO RANCH LLC
Entity type:Organization
Organization Name:SH1 CINCO RANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-998-5810
Mailing Address - Street 1:5101 NE 82ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6343
Mailing Address - Country:US
Mailing Address - Phone:360-254-9442
Mailing Address - Fax:360-254-1770
Practice Address - Street 1:3206 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-6233
Practice Address - Country:US
Practice Address - Phone:281-559-3334
Practice Address - Fax:281-559-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility