Healthcare Provider Details

I. General information

NPI: 1760111207
Provider Name (Legal Business Name): EKKO HQ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NE HAWTHORNE AVE STE 112
BEND OR
97701-4690
US

IV. Provider business mailing address

150 NE HAWTHORNE AVE STE 112
BEND OR
97701-4690
US

V. Phone/Fax

Practice location:
  • Phone: 916-225-3144
  • Fax:
Mailing address:
  • Phone: 916-225-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANTHONY FREDERICK STONE
Title or Position: CEO
Credential: BS, MS AEROSPACE
Phone: 916-225-3144