JEFFERSON MANOR RESIDENTIAL CARE, LLC (NPI# 1669633707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669633707 |
| Entity Type | Organization |
| Organization Name | JEFFERSON MANOR RESIDENTIAL CARE, LLC |
| Other Organization Name | JEFFERSON MANOR |
| Practice Address |
664 Se Jefferson St Dallas OR 97338-2024 |
| Mailing Address |
200 Hawthorne Ave Se Ste A140 Salem OR 97301-5092 |
| Practice Telephone | 5036238104 |
| Practice Fax Number | 5036230772 |
| Mailing Telephone | 5035882725 |
| Mailing Fax Number | 5035888653 |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2008-06-20 |
| Authorized Official Name | ELIZABETH MARIE MOSS (DIRECTOR OF RISK MANAGEMENT) |
| Authorized Official Telephone | 5035882725 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311500000X | Alzheimer Center (Dementia Center) | 1087658107 | OR | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 515448 | 05 |
| Other Name | Type Code |
|---|---|
| Jefferson Manor | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | JEFFERSON MANOR RESIDENTIAL CARE, LLC | 200 Hawthorne Ave Se Ste 1-140, Salem, OR 97301 |
| Street Address |
664 SE JEFFERSON ST |
| City | DALLAS |
| State | OR |
| Zip Code | 97338-2024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164932042 | Stephanie Marie Renfro | Massage Therapist | 289 E Ellendale Ave #601, Dallas, OR 97338 | 2017-10-05 |
| 1588185953 | Herbert Starr Woodward IIi | Dentist | 201 Se Washington St, Dallas, OR 97338 | 2017-07-06 |
| 1851708077 | David Mooso | Pharmacist | 321 Nw Kings Valley Highway, Dallas, OR 97338 | 2014-07-21 |
| 1841615556 | Leslie Lytle | Counselor | 1020 Sw Maple St., Dallas, OR 97338 | 2014-03-04 |
| 1205265493 | Chung-fan Ni | Counselor | 182 S. W. Academy St., Academy Building, Dallas, OR 97338 | 2013-11-07 |
| 1215204300 | Ron Fritz | Counselor | 239 E. Ellendale, Suite 602, Dallas, OR 97338 | 2011-11-17 |
| 1235420167 | Deborah Kennedy | Counselor | 527 Ne Fern Ave, Dallas, OR 97338 | 2011-04-26 |
| 1821229774 | Chelsea Ruhoff Lee | Physician Assistant | 1000 Se Uglow Avenue, Flaming Medical Center, Dallas, OR 97338 | 2009-07-27 |
| 1013128560 | Larry J Vuylsteke | Social Worker | 182 S.w. Academy, Dallas, OR 97338 | 2007-05-25 |
| 1093926123 | Justin W Reed | Counselor | Academy Building, 182 S.w. Academy St. Suite 304, Dallas, OR 97338 | 2007-05-24 |
| Find all providers in zip 97338 | ||||
| Taxonomy Code | 311500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Alzheimer Center (Dementia Center) |
| A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer’s Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265727531 | Loyds of Dallas Enterprises, LLC | Alzheimer Center (Dementia Center) | 5105 Creighton Dr, Dallas, TX 75214-2127 | 2011-06-15 |
| 1699081612 | East Run Management, Ltd. Company | Alzheimer Center (Dementia Center) | 2653 Cedar Crest Blvd, Dallas, TX 75203 | 2010-08-27 |
| 1396071254 | Esc Iv, Lp | Alzheimer Center (Dementia Center) | 9271 White Rock Trl, Dallas, TX 75238-2552 | 2009-10-28 |
| 1811161979 | Tata Consultancy Services Americas | Alzheimer Center (Dementia Center) | 18240 Midway Rd, 1303, Dallas, TX 75287-4923 | 2008-04-18 |
| 1346578770 | Konektz LLC | Alzheimer Center (Dementia Center) | 13521 Method St, Dallas, TX 75243-1409 | 2009-11-23 |
| 1265769582 | Jcs Lake Highlands Operations Lp | Alzheimer Center (Dementia Center) | 8615 Lullwater Dr, Dallas, TX 75238-4754 | 2009-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518567502 | Bend Arbor, LLC | Alzheimer Center (Dementia Center) | 1290 Sw Silver Lake Blvd, Bend, OR 97702-2236 | 2020-10-28 |
| 1710504782 | Rsl Eugene, LLC | Alzheimer Center (Dementia Center) | 2730 Bailey Ln, Eugene, OR 97401-6923 | 2020-06-25 |
| 1427674852 | River Grove Operating Company, LLC | Alzheimer Center (Dementia Center) | 140 Green Ln, Eugene, OR 97404-2441 | 2020-06-22 |
| 1336765759 | West Salem Memory Care LLC | Alzheimer Center (Dementia Center) | 2030 Wallace Rd Nw, Salem, OR 97304-2123 | 2020-06-22 |
| 1205452638 | Wmc Operating Company, LLC | Alzheimer Center (Dementia Center) | 2325 N Boones Ferry Rd, Woodburn, OR 97071-9627 | 2020-06-22 |
| 1457977134 | Bridge Creek Investors LLC | Alzheimer Center (Dementia Center) | 1401 S 12th St, Lebanon, OR 97355-1201 | 2020-06-18 |
| 1013533710 | Valley View Investors LLC | Alzheimer Center (Dementia Center) | 112 Valley View Dr, John Day, OR 97845-1286 | 2020-06-18 |
| 1023634854 | Rsl Springfield, LLC | Alzheimer Center (Dementia Center) | 6135 E St, Springfield, OR 97478-7023 | 2020-06-17 |
| 1093331811 | Rsl Medford, LLC | Alzheimer Center (Dementia Center) | 1530 Poplar Dr, Medford, OR 97504-4612 | 2020-06-17 |
| 1760008684 | Rsl Gresham, LLC | Alzheimer Center (Dementia Center) | 1655 Ne 18th St, Gresham, OR 97030-4113 | 2020-06-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.