CRYSTAL TERRACE (CRYSTAL TERRACE RETIREMENT COMMUNITY, LLC) NPI 1003038134

Assisted Living Facility in Klamath Falls, OR

NPI 1003038134 Organization Assisted Living Facility CLIA Number 38D2150924 CLIA Certificate of Waiver

About CRYSTAL TERRACE (CRYSTAL TERRACE RETIREMENT COMMUNITY, LLC)

Crystal Terrace (crystal Terrace Retirement Community, Llc) is a provider established in Klamath Falls, Oregon specializing in assisted living facility. The NPI number of Crystal Terrace (crystal Terrace Retirement Community, Llc) is 1003038134 and was assigned on May 2007. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Crystal Terrace. The authorized official of this NPI record is Jon Harder (Manager)

The CLIA number of Crystal Terrace is 38D2150924 registered as a "assisted living facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Crystal Terrace to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003038134

Provider NameCRYSTAL TERRACE (CRYSTAL TERRACE RETIREMENT COMMUNITY, LLC)
Provider Location Address1000 TOWN CENTER DRIVE KLAMATH FALLS, OR 97601
Provider Mailing Address3723 FAIRVIEW INDUSTRIAL DR SE SUITE 270 SALEM, OR 97302
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameCRYSTAL TERRACE
Other Name TypeDoing Business As (3)
Enumeration Date05-02-2007
Last Update Date08-22-2020


Primary Taxonomy

Taxonomy Code310400000X
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Business Address

CRYSTAL TERRACE
1000 TOWN CENTER DRIVE
KLAMATH FALLS, OR
ZIP 97601
Phone: (541) 885-7250

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Mailing Address

CRYSTAL TERRACE
3723 FAIRVIEW INDUSTRIAL DR SE
SUITE 270
SALEM, OR
ZIP 97302
Phone:



Authorized Official

Authorized Official Name JON HARDER
Authorized Official TitleMANAGER
Authorized Official Phone(503) 485-4600

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003038134 is:

CLIA Number38D2150924
Facility TypeASSISTED LIVING FACILITY
Certificate TypeCertificate of Waiver

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.