| Organization Name: | MEADOWLAND ADULT FOSTER HOME LLC |
| NPI Number: | 1508215252 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUJAY KUMAR NAKKA (OWNER) |
| Mailing Address: | 706 Meadow Ave Tillamook |
| State: | OR US |
| Postal Code: | 971412844 |
| Phone Number: | 5033542523 |
| Fax Number: | 5033545116 |
| NPI Enumeration Date: | 06/03/2016 |
| NPI Last Update Date: | 06/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3104A0630X |
| License Number: | 500697789 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | Assisted Living, Behavioral Disturbances |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |